Showing posts with label medicalization. Show all posts
Showing posts with label medicalization. Show all posts

March 22, 2012

Do Drugs and Alcohol Make You Sick?

Since we missed a day of class, I am turning Thursday's lecture into a blog post, so you can make sense of why I assigned the readings that I did. We will be discussing Tuesday's readings in class.

For Thursday, I asked you to read five short articles about drugs and alcohol. You may have wondered why I included these in a section on deviant minds. I think we all know that doing illegal drugs is considered deviant, to various degrees, and some of you may include alcohol in your personal definition of deviance. But I want to talk about drugs and alcohol from a different angle. How much is too much? How much consumption is "normal" and when does that cross over into too much? When is that too much considered fun, and when is it considered an illness, or a problem that needs to be fixed? Who gets to make those determinations?



If we were in class, I would ask you this question: is alcoholism/drug addiction an individual problem? Or a societal issue? As with the other topics we have discussed this semester, we have been sold an image in the United States that a person who drinks too much is sick. They can't help their consumption; it's a lifelong disease, with no cure.

So then let me ask you this: is drinking deviant? Think about how deviance is a social construction, in how it varies by time, person, location and context. The same behaviors you exhibit at 21 (give or take), such as binge drinking, are charming--even expected--when you are a traditionally-aged undergraduate (especially if you are in Pullman). Is it always charming? Do race, class, gender, size, ability or sexual orientation make a difference in how "deviant" or not that behavior is perceived? What happens when your 64-year-old professor shows up and gets in line to do a keg stand? Is that same behavior now a little suspect? A little....problematic? What assumptions do you start making about that professor, especially if she's a woman (spot check: what gender did you have in your mind when I said "professor"?)? Has drinking always been considered a problem? Or is that a relatively new construction? Would the same level of consumption be seen as deviant anywhere in the world? Look at how we have regulated alcohol consumption over time, as discussed in the article about the drinking age. As with other categories (like race, gender, size, ability, et al.) we have discussed this semester, age is a social construction. What behaviors and abilities we correlate with which ages are a fluid construction of our making, and the debates around the drinking age show that well.



In the United States, and now around the world, we have an organization called Alcoholics Anonymous. They have done tremendous work to help people stop drinking when they find it is interfering with their life in various ways. In no way do I want to diminish the work they do. I would like you, however, to take a step back and look at how they have shaped our understanding of alcoholism. They, along with a broader social movement, have given a set of behaviors a name (label), and have really changed the way we look at that label. At this point in our history, you are far more likely to see sympathetic portrayals of alcoholics, struggling valiantly with a disease than you would have seen a generation ago. They have been part of an overall reframing of alcohol consumption being a medical issue--they are part of an example of medicalization, as we have discussed in this section. In a way, they have switched the view of alcoholism from being an achieved status to an ascribed status, at some level.



Right now, you could take an online quiz somewhere, and it would tell you if you are an alcoholic. We have a whole list of behaviors that we see as "symptoms" signaling a "problem." And, luckily, groups like AA can offer you a solution. Unlike many of the groups we have discussed this semester, they are not offering their solution to make a profit. But they have created almost a monopoly on the solution. It's their program, or you're not fixing your problem correctly--even the criminal justice system seems to agree, when they mandate attendance at meetings.



What is the consequence of that medicalization? Now that we have these clearly defined symptoms, we see certain behaviors as pathological. Before, maybe you got an eyeroll. Now you get a headshake, and a court mandate. We believe people that drink too much--or in certain ways--are sick. That is a social construction, created by a social movement. Their intentions are positive, perhaps, but it still has consequences. Once you are labeled an alcoholic, that becomes your master status. You know the story from here.

That pathologization has spread to drug consumption in similar ways. Though drugs have been handled differently in our laws compared to alcohol, they too have been medicalized in our culture. Just like you can go to an AA meeting, you can go to a meeting for Narcotics Anonymous, or Crystal Meth Anonymous. Name your "problem" drug, and there is a 12 step solution for you out there. For every drug, there is a support group saying "we know, you couldn't help it, but now we can help you."

There is a positive and a negative impact from this pathologization. It takes the blame off of the individual, in one way, but puts it right back on them with the label of "sick." Is that a fair trade off?



Is drug use a problem? If so, how much is too much? How should it be regulated? Who should decide when it is too much, legally, or medically? How, as a society, should we handle drugs? How have we reacted to the use of drugs we have chosen to make illegal? Are some drugs more deviant than others? Does the deviant label depend on your race, class, gender, ability, et al.?



If you look at the billboards out there trying to stop people from doing crystal meth, they give a very particular message--don't use meth, because it will make you ugly. Are scare tactics the answer? If drugs are a problem, are scare tactics the answer? Research says that youth overestimate the impacts of cigarettes--they actually think they are more harmful than they really are. But that doesn't stop them from smoking. Smoking is cool, and youth often feel invincible.



Is it ever deviant to not do a drug? Is there a pressure to participate in some consumption, such as alcohol or pot? Why is pot a controlled substance? Has it always been illegal? Why is it still illegal? Pot is a great example of a form of deviance being a social construction. It wasn't illegal in the United States. And then it was. And how it became illegal was largely based in politics and lobbying, not for medical reasons, or because of crime problems. To justify making it illegal, the culture had to reframe the way they thought about pot. They had to start seeing it as a "problem" that needed to be controlled, in the eyes of the public, and in the ears of the legislators. Some groups helped to make this happen by using propaganda, including the infamous film Reefer Madness (1938), filled with scare tactics (you've got to protect the children!).



If you really dig into the history of how pot became illegal, you will see it wasn't to help society, it was to make money. And they used racist insecurities and fears to turn the country against a substance they once enjoyed, or at least viewed as neutral.



Why does a society control alcohol and/or drugs? Do we need the government to save us from ourselves? Or is it because controlling alcohol and/or drugs helps society? Certainly, drugs and alcohol cost society, in car accidents, health care, and lost productivity taking away from our economy. But are there also benefits to the consumption of drugs and alcohol?

I gave you two readings about the social harm of drugs. What does the most harm? If we are really legislating drugs to help society, why are we not controlling the drug that causes more harm than all the others, by far--alcohol? Who has the best political lobbyists? Who stands to make money by alcohol sales? If pot could make that much money for some people, would it suddenly be legal? If marijuana had the same political power as alcohol, what would happen? Would it be legal? Could it not just be legal, but woven into our culture as the ultimate party device, as alcohol is?



We have a twisted relationship with alcohol in our culture. We love it, it makes you sexy and cool, but don't drink too much....because that's sick. Why? Why are prescription drugs not treated the same way? Who can afford prescription drugs, and who can afford "street" drugs? How does that influence how we see deviance? Our definitions of deviance, when it comes to drugs and alcohol, are complex, and our messages often contradict each other.

March 2, 2012

Drug Trials in India

Here is a story that is just coming out today, on how drug testers are turning to the poor areas of India to do their drug testing, so they can workaround all of the rules we use in the U.S. to protect people during human drug testing.

'People keep falling sick': How Poor Indians are Recruited for Clinical Drug Trials

"Drug trial outsourcing to foreign countries is rapidly becoming an attractive alternative for U.S. pharmaceutical companies looking to save millions of dollars, avoid regulatory scrutiny and tap into a seemingly endless supply of drug study participants.

But a year-long Dateline investigation into one of the preferred destinations for overseas drug trials, India, raises questions about lax regulatory oversight in these studies, the integrity of some of the companies contracted to run them and the reliability of the data they produce. "

Read more here.

February 27, 2012

Blog Post 4: Story of an Illness

For this section of the course, we are talking about how some people get labeled "sick" for the way their minds work. This is an extremely difficult topic, with much emotion and controversy wrapped up in those labels. It seems that some behaviors people used to shrug off as somewhere in the range of "normal" are now considered problematic. And some behaviors that used to be seen absolute as a sign of mental illness (like homosexuality) are no longer perceived that way (at least by most).

For some, getting a label of a mental illness has been life-saving and affirmative. Not only does it offer them an explanation for whatever symptoms they have been experiencing, but it also offers a chance at treatment. And, because we rely so heavily on insurance, receiving an official diagnosis is often a necessary step for getting therapy and/or treatment. Being given a label has also meant that individuals facing similar issues, barriers and concerns can form community together, and bond over their common experiences. With all of our technological advancements, we keep learning more about the body, and our brains--so are these new and expanded labels helpful? Are they getting us closer to the truth?

One of the downsides to getting a label of mental illness is the stigma that comes with such labels. Such a stigma is potent, because, as we have discussed about labels, they come with a whole package of assumptions. We see people with mental illnesses as "sick" but what else comes in that package--sick? Crazy? Unstable? Dangerous? What happens when your mental illness becomes your master status? Once you have been labeled, are you seen the same by society? Do you still have the same opportunities as everyone else? Or do your choices become more constrained?

One of my favorite examples of this quandary--should we accept this label or not?--is in a really fascinating story of Emanuel Frowner, from the outstanding podcast Radiolab. In the story of the Frowners, the father of the family refuses to believe that Emanuel has any problems, but his other son can see that Emanuel has textbook symptoms along the autism spectrum. Dad wants to avoid Emanuel being treated differently, but his brother wants him to get help--what is ultimately the best thing for Emanuel? The story is moving, and even the comments on the web site are telling about how difficult these decisions are. The clip is about 19 minutes, and is well worth a listen (sorry about the ad!).

There are also more sides to this discussion. For example, who stands to benefit from more widespread diagnoses of mental illnesses? Certainly, pharmaceutical companies stand to make enormous amounts of money from some diagnoses. As we have touched upon in class, there is much more money to be made in treatment than prevention. Does having the potential for profits change the way such companies look at medicine? Are these companies doing great work to solve our health problems, are they looking at more markets to tap, are they impacting policy in powerful ways, or or is there even more going on? What should be the role of drug companies in educating doctors, or the public, about medicine?



The Diagnostic Statistical Manual (DSM) is called "the bible" when it comes to diagnosing mental illness. The DSM-V is scheduled to be released in May 2013 and the process of updating it has been nothing short of intense. Right now at least 8 conditions considered "disorders" will be removed. Various groups have lobbied, protested or fought in a myriad of ways to get their illnesses labeled, so they can get health care, or removed altogether. And those groups are infighting with each other, because some want the label to access health benefits, and others are fighting the stigmas. Should this be how diagnoses are made? By political lobbies and activism, or are decisions made based on sound scientific evidence? And who pays for that scientific evidence--it really gets that messy. On top of everything, many of the people charged with updating the new DSM-V clearly stand to make a lot of money on the very changes they are voting on--should this conflict of interest, which impacts up to 70% of the panel members, be allowed?

For your fourth blog post, you will do your best to disentangle all of this in regards to an "illness" of your choosing. You can choose something that used to not be labeled an illness, but is now, or something that is no longer considered an illness. Or something that is currently going through a surge of awareness, and heightened diagnoses, like autism or ADHD (both of which we will begin to discuss in class). Really, it can be any illness you want to know more about. More than giving a history, you are going to give us an analysis of what has been involved in the process of this illness gaining, or losing, that label. You are going to tell us the academic story of that illness.

Choose something that has been deemed an "illness" either informally, or formally in the DSM. Not necessarily eyelashes--try to take on something with broader implications. Give a brief history of the diagnosis, or medicalization of that illness, then give a sociological analysis of the illness, using questions like these:
  • What were the behaviors or attributes that were seen as deviant, and how did they become seen as deviant/normal?
  • What was the process of medicalization (or demedicalization?) for this illness?
  • Who were the major players in the decision-making process, as far as you can find?
  • What parties stand to gain from the diagnosis?
  • What parties stand to lose from the diagnosis?
  • Are the people that will be impacted by the label part of the conversation, at all?
  • How did/does information spread about this illness?
  • What were/are the roles of social institutions in creating/maintaining the "sick" label?
  • What are the consequences (positive and negative) of having this diagnosis?
  • Are some groups more or less likely to be diagnosed with this illness?
  • What are the underlying social constructions of race, class, gender, size, ability, sickness, mental health, age, beauty, normal, deviance, sexuality, and so forth that impact this illness, and/or its perception?
  • Once this label is assigned, do we as society take any responsibility for the care of those who are labeled? Should we?
  • Who benefits from this illness being seen as an individual problem?
  • What are the possible social reasons for the existence of this illness?

A thorough post will include as many sides of the discussion as possible, to try to show just how complex this all is, and will do a really solid job of connecting to the concepts and materials from the course to their examination. My standards are only increasing; if you have any doubts, make sure you visit the writing center. At this point we should be past any typos or citation errors. Remember you must utilize and cite at least three of the assigned course materials, and you must EXPLAIN sufficiently how they connect to your analysis.

Not sure where to start? Here are a few suggestions, and some links to some places to start your thinking (also, of course, look at the required readings). Once you choose one, if you need some guidance, feel free to email me and/or set up a time to talk--I am always happy to bat around ideas with students. You will probably find you need to go back into the deviance blogs, so you can make sure you are getting a wide representation of perspectives and voices on the impact of these deviant labels (see the list on the right side of the page).

This is not necessarily reflective of what is "out there" but is just pulled from my personal collection I have gathered over the past few years of teaching this course.

Autism/Asperger's
ADD/ADHDGender Identity DisorderHomosexualityAlcoholism/Drug AddictionObesityDepression/Mental Illness (sorry to lump these--please be more specific in your own project)
Developmental, intellectual or physical disabilities (sorry to lump these--please be specific for your own project)
Sex AddictionViolenceBonus thoughts: