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Conrad 1979 Types of Medical Social Control PDF
Conrad 1979 Types of Medical Social Control PDF
Conrad 1979 Types of Medical Social Control PDF
Abstract In recent years there has been considerable interest in the social control
aspects of medicine. While medical social control lias been conceptual-
ized in several ways, the concern here is with the medical control of
deviant behavior, an aspect of what has been called the medicalization
of deviance. Medical social control is defined as the ways in which
medicine functions (wittingly or unwittingly) to secure adherence to
siicial norms; specifically by using medical means or authority to
minimize, eliminate or normalize deviant behavior. This paper cata-
logues and illustrates a broad range of medical control of deviance,
and in so doing conceptualizes three major types of medical social
control: medical technology, medical collaboration, and medical
ideology. Numerous examples are provided lor each. These concepts
aid in revealing the breadth of medical social control and the extent
and limitations of professional dominance over the medical social
control of deviance.
In recent years there has been considerable interest in the social control
aspects of medicine. Medicine was first conceptualized as an agent of
social control by Parsons (1) in his seminal essay on the 'sick role'.
Freidson (2) and Zola (3) have elucidated the jurisdictional mandate
the medical profession has over anything that can be labeled an illness,
regardless of its ability to deal with it effectively. The boundaries of
medicine are elastic and increasingly expansive (4), and some analysts
have expressed concern at the increasing medicalization of life (5).
While medical social control has been conceptualized in several ways,
including professional control of colleagues (6) and control of the
micro-pohtics of doctor-patient interaction (7), the focus here is
narrower. My concern is with the medical control of deviant behavior,
an aspect of what has been called the medicalization of deviance (8, 9).
Thus, by medical social control I mean tlie ways in which medicine
functions (wittingly or unwittingly) to secure adherence to social
norms; specifically, by using medical means to minimize, eliminate, or
normalize deviant behavior. While there has been considerable research
on medical social control, there has been no attempt to order and
analyze the variety of medical controls. The purpose of this paper is to
cataglogue and illustrate the broad range of medical controls of deviance.
This section of the paper discusses the relation of the medical pro-
fession to each type of medical social control. Given the dominance of
the medical profession in western society (2, 31), one might suspect
that medical control of deviance was squarely in the hands of the
medical profession. A number of writers have assumed medical
hegemony, monopoly or imperialism in the expansion of the sphere of
medical control (4, 32). While in individual cases this may present an
accurate picture, upon closer inspection we find that the determination
and control of each of these controls varies considerably. We identify
three factors affecting the medical profession's control of medical
controls: the necessity of active involvement of medical professionals,
the ability of non-medical segments of society to limit or demand
medical social control, and the source of instigation of medical control.
Medical technology and collaboration both require the active partici-
pation of medical professionals. Only the medical profession has the
license and mandate to legally use behavior-controlling drugs and to
perform surgery. Without the involvement of physicians, medical
technology cannot be implemented. Medical ideology, on the other
hand, can exist without the active participation of medical professionals.
Frequently non-medical groups, such as Alcoholics Anonymous and the
early juvenile court (33), adopt a medical ideology or rhetoric in their
social control work. The involvement of the medical profession is
marginal at best, and more likely, non-existent. Fledgling professions or
semi-professions (34) may adopt a medical ideology in their work in
order to benefit from the prestigious cloak of medicine and enhance
their own professional status.
The ability of agents outside of medicine to require or limit the use
of medical controls varies for the three types of control. The application
of medical technology by and large belongs solely to the medical pro-
fession. This medical monopoly may be somewhat restricted by govern-
mental regulatory agencies such as the Food and Drug Administration,
by the courts, or through special legislation. But the actual limitations
8 Conrad
on medical control by these agencies is limited - it is usually tlie result
of a specific controversy (e.g., XYY research witli newborns), the
specific restrictions of a specific drug, or a specific legal issue (e.g.,
informed consent and psychosurgery). Generally speaking, the pro-
fessional dominance of medicine is most evident here, as the extra-
medical agents must engage in battle if they wish to limit the medical
profession's primacy in the use of medical technology. Medical collab-
oration by definition involves some relationship with another insti-
tution. In nearly all examples of medical collaboration cited above,
medicine performs reporting, definitional or technical tasks for another
institution. Physicians are significantly constrained by these relation-
ships: they may be required to report information (as in child abuse) or
may have their range of medical judgment limited by the demands of
the 'collaborating' institution (as in the military). Medical dominance
and professional freedom in use of expertise is thus significantly
curtailed in collaborative social control. Medical ideology can be greatly
affected by non-medical agents in society. Althougli medical pro-
fessionals may use medical ideology as social control, it is not the sole
property of the medical profession or its related professions. Self-help
organizations like Alcoholics Anonymous or weight-reducing groups
(35) can adapt or develop their own quasi-medical theories apart from
medical professionals. These theories may of course be challenged by
medical professionals, but here the challenge must come at the insti-
gation of the medical profession." The medical profession claims, but
has no ownership of, medical rhetoric and vocabulary. It can be used by
other organizations independently ofthe medical profession. Physicians
may disown or challenge a particular use of medical vocabulary, but
they must challenge it through the media, courts, the legislature or in
some other public arena.
Finally, source of instigation varies for the three types of social
control. Medical technology includes surgical procedures, drugs and
technological innovations. While psychoactive dmgs and advanced
medical apparatuses are often invented and promoted by corporate
interests, they only can be implemented by medical professionals.
(This is why the pharmaceutical industry spends 25 percent of its
gross budget on physician advertising.) The implementafion of surgical
procedures by physicians is among the most laissez-faire of modern
medicine (36). Physicians may not be the original instigators of specific
medical technologies, but they are invariably in control of its
implementation. Medical collaboration is nearly always instigated out-
side the medical profession. Even in the case of child abuse where some
physicians championed the cause (37), it was the state's passage of
mandatory reporting laws that instigated the use of medical control.
Types of medical social control ^
Witli medical excusing or gatekeeping tasks, as well as with mucli
medical work in institutions, medical control occurs at the instigation
of agents outside the medical profession. Medical ideology may be
instigated eitlier inside or outside tlie medical profession: physicians'
entrepreneursliip of new diagnoses or disorders, or non-medical
adoption of medical definitions, rlietoric or vocabulary may extend
medical ideology.
To summarize, while many analysts liave written of the professional
dominance of medicine, our analysis reveals that only in terms of
medical technology does the medical profession maintain dominant and
monopolistic control. When medicine operates in a collaborative role, it
shares control with otlier institutions or performs work in the service of
another institution. Medical ideology may arise independently from the
medical profession; for the medical profession to maintain dominance
over this form of social control, it must publicly cliallenge those groups
utilizing medical ideology.
Conclusion
References