Recently, I have been thinking a lot about how much of our lives are being captured and translated into numbers, percentages, and statistics. It seems that no matter where one turns, some aspect of our social life is being measured quantitatively. Of course, this is not a new phenomenon – things like age, weight, body mass index, intelligence quotient, height, and physical aptitude scores have been with us for some time now. However, it appears that this movement to quantify and measure aspects of our social life and then translate them into numbers and statistics has increased with great haste; perhaps resembling a juggernaut out of control. While gaining acceptance among many circles and embraced as a way to better one’s life, this movement as often been termed as the ‘quantified self’. (more…)

Foucault wrote that the nineteenth century ushered in a new way to inspect the body; recognizing that medical personnel had placed the patient under “perpetual examination” (1975). His interest, however, was on the discourse that produced, maintained, and extended the medical look or “gaze” (1975). The “clinic,” for Foucault, became an apparatus of examination; a site of knowledge production bound by rules and regulations. It became an authoritative institution where the individual became the object of scrutiny (Long, 1992).

Following Foucault, there can be little doubt that the medical field has garnered power and authority in today’s society. Its utility and influence can be found in school immunizations, sports-related physicals, annual check-ups, seasonal vaccinations, yearly shots, and the like. However, as Conrad (2007) notes, this is only part of the picture. He, among others, proposes that the medical field has grown beyond shots and treatment; those in the medical profession now have the authority to define and/or redefine once thought non-medical issues as medical conditions. (more…)

A careful understanding of epigenetic mechanisms allows sociologists to include a new biological perspective into research designs – when it is incorporated carefully and not used casually or blindly as a deus ex machina explanatory device that is.

Epigenetics provides us with one of several “mechanisms by which social influences become embodied” (Kuzawa and Sweet 2008: 2). A promising place for sociologists to enter into this research or use it fruitfully is to examine how social environments and inequalities become embodied as epigenetic imprints, altering gene expression and consequently affecting a wide array of health outcomes. Additionally, while mapping the epigenome, epigeneticists are exploring differences in the plasticity of particular alleles at various points in the lifecourse. Could the inclusion of epigenetic biomarkers in sociological work allow for the separation of early life events from cumulative ones?

These mechanistic stories are bound to be messy, but such feedback loops and the enmeshment of social and biological processes are inescapable. With the knowledge and technology available today, we are far beyond oversimplified nature versus nurture debates. Many biologists who do epigenetic work realize that in order to get a complete, complex mapping of these mechanisms, the social needs to be included. These biologists view sociological and cultural variables as more of a signal rather than just contextual noise. Sociologists should not only collaborate with such researchers, but also help shape what these projects look like.

Further, sociologists should be aware of developing epigenetic discourse and how it is being received in the media. Over the past year or so, non-scientific magazines from Time to Newsweek have picked up on epigenetic findings, publishing articles for the general public on the topic. However, not all of this reporting clearly emphasizes epigenetics’ softening of geneticization’s hard line determinism. Further, some of it mistakenly over-emphasizes our agency in the changing of our own and our future generations’ genetic code. Sociologists should be aware of such reporting, lest it follow the route of the powerful, persuasive, and pervasive hold the narrative of geneticization has in everyday, non-scientific talk (Chaufan 2007) – especially since general understandings of genetic findings often easily allow genetics to take the stage as a deus ex machina of causal efficacy despite findings that clearly prove otherwise.

What is Epigenetics?

Controlling Your Genes

DNA: How You Can Control Your Genes, Destiny

Ghost in Our Genes

In mid February 2011 The Guardian newspaper published an edited version of David Faulkner’s contribution to the United Kingdom’s Centre for Crime and Justice Studies’ report “Lessons for the Coalition” which was written in response to the first report of the National Preventative Mechanism – a new body set up under the optional protocol to the UN convention against torture. The National Preventative Mechanism’s report highlighted problem areas in the UK’s approach to mental health, resources, vulnerable groups such as women, children, those with disabilities and those who misuse drugs or alcohol, the size of the prison population and the right to dignity.

Mr. Faulkner’s contribution to the Lessons for the Coalition report asks, specifically, what can be done to improve the criminal justice system in a time of austerity? He highlights the shift in approach to criminal justice in terms of expected outcome. He charts a shift from moderation and restraint in the use of punishment to also making the system fairer and work better rather than also working to understand how to solve the problem of crime through more effective policies. He notes that despite some overall improvements, “there is still confusion in the courts, especially over sentencing; a prison system in constant crisis; and continuing demand for reforms in the police and penal system.”

In an effort to move forward in criminal justice improvements in a time where the funding for a variety of public policies is under scrutiny, Faulkner discusses the emphasis on partnerships and collaboration between government departments, local authorities, statutory services and the private and voluntary sectors. In this way, rehabilitation can continue to be a central focus but with greater consolidation of efforts through collaboration rather than the bureaucratic duplication of processes. However, he is also careful to point out that there are some important gaps that will need to be tended to- particularly in the connection made between rehabilitation and the social conditions enabling crime to take place, including deficiencies in other areas of social policy.

It is precisely this gap that concerns sociologist Rebecca Tiger. In her article “Drug Courts and the Logic of Coerced Treatment”, published in the March 2011 issue of the Sociological Forum, Tiger examines how scientific theories couple with moral considerations to create a more “enlightened” approach to the incredibly complex problem of addiction. In examining the model of coerced treatment through drug courts Tiger highlights the rehabilitative and repressive approaches that characterize the criminal justice system in the United States. (more…)

Deafness and hearing loss is a condition or state of being whose meaning is contested. The biomedical, or infirmity, understanding of deafness is that hearing loss is a disability that, in many cases, can be cured or ameliorated through advanced technological devices and procedures, including surgery and internal and external prostheses. The newest of these technologies, cochlear implants, can help a deaf infant hear and speak in almost the same way as a hearing person.

As opposed to the biomedical model, a cultural understanding of deafness understands deafness to be a physiological difference around which a rich linguistic and cultural heritage has evolved. The cultural model does not understand deafness as something to be corrected, but rather as a natural, unproblematic state. Deaf proponents of the cultural understanding of deafness identify as members of a linguistic minority and culture group, referred to as the Deaf-world.

It is tempting to reify physical conditions, such as deafness, as “real” biological entities that are outside the influence of social forces. Reification is the social process of attributing absoluteness and naturalness to the purely conventional, and carries with it the risk that reified processes appear to lose their social character. Reification turns human products into something other than human products, such as facts of nature, thereby allowing humans to forget their own authorship of the phenomenon in question. Because of the biological nature of physical abilities such as hearing, specialists and laymen alike forget the purely conventional and social nature of disability classifications, and instead attribute a profound natural power to these categories. As a result of this flexibility, bodies themselves are a highly contested space, in which competing cultures vie for the right to define and sculpt that body. Defining a body as disabled or abled does not occur in a vacuum, nor is it an automatic classification; instead, it is always in contrast to the normal that the abnormal is understood.

In the contemporary era, an adult or child is first identified as hearing or deaf through audiometric testing. In 2006, 96% of American newborns received their first audiometric test within hours of birth (National Center for Hearing Assessment and Management 2009). At the point of being so labeled, an individual or parent is faced with two broad options. They can chose to incorporate the infirmity model of deafness into one’s own world view and, accordingly, seek hearing and speaking correction in an attempt to conform and achieve normality. Those who adopt corrective technologies such as the cochlear implant in an attempt to conform affirm that deafness is in fact a disability that can and should be corrected. Alternately, one can resist the conforming process, thereby resisting the label and the association of deafness as a disability in need of correction.

The affirmation of the infirmity understanding of deafness leads to the search for new and better technologies to address deafness, including stem cell research and gene transfer therapies that aim to ultimately eliminate the birth of deaf infants. This work is done partially to eliminate the stigma of deafness. These advanced techniques, if “successful,” will have the effect of regulating and eventually eliminating Deaf culture, language, and Deaf people altogether. These attempts are seen by those adopting a cultural understanding of deafness as parallel to eugenics or genocide. Although the term eugenics implies the reduction or elimination of deafness through compulsory exogamous marriage and sterilization or through gene therapy, genocide evokes a more active attempt to eliminate a group of people or a culture. The word genocide recalls vast pogroms and systematic killing, however, the slow elimination of a minority group can occur by the destruction of the distinct elements that bind the collectivity, such as language, customs, and art forms. Because the infirmity model of deafness aims to eliminate the need for American Sign Language (ASL), the loss of this language could result in the loss of the culture itself. In this way, language death, or glottocide, can lead to the loss of cultural identity, and may represent the denial of the basic human and civil rights of children to speak their native language.

Perceptions of and Responses to Stigma

Recently, there have been many suggestions that a backlash against the unilateralism of the biological approach in medicine is on the brink. Perhaps, some suggest, patients have garnered some say in their treatment, even though many researchers suggest that modern medical practice strips patients’ rights to make their own decisions. But where ought the boundary between patient autonomy and doctor totalitarianism be? On the one hand, purely diagnostic, biomedical medicine that does not allow for patients’ own insight into their conditions,  makes patients feel objectified, as if they are nothing more than a disease. On the other hand, doctors have a certain expertise and patients may not always know what’s best for them. After all, medical training is difficult, arduous, and produces a professional with an important and valuable set of skills. Certainly, options beyond the biomedical model would allow patients to have increased autonomy and say in their care. The availability of, for instance, acupuncture and herbal supplements has allowed many patients with a range of conditions from depression to back pain to find relief in a treatment that, at one time, would never have been (and still often isn’t) considered acceptable treatment in a Western medical perspective.

What would it mean for the effectiveness of treatment if patients begin to have more of a say in their treatment? When patients come into doctors’ offices asking for certain procedures, tests, and even medicines, it represents an informed consumer, but also a patient who may be less receptive to the advice of doctors. The question is: how do we find a balance between patients being able to chose the kind of treatment they want and being truly listened to by their doctors (rather than simply diagnosed as a medical object)?

Nathenson (2010, see below) suggests that the biomedical model may not be the dominant lens in the future. While this seems like it is still a distant possibility, Nathenson describes an increasing medical pluralism because of more patient autonomy.  This is a crucial question – how should we study these various ways of treating illness and understand how the dominance of these models are maintained. I say we also need to examine how much autonomy is really useful in medical treatment. I’m not convinced that patients can be fully autonomous in any kind of treatment, though certainly some models preclude much more autonomy than others.

MRI’s as you see to the left, medications, and other medical technologies are powerful tools that reinforce the legitimacy of the medical profession, which is currently dominated by the biomedical model, for better or worse. And there are major benefits of this diagnostic model, even if it tends to ignore the patient’s voice. In the article below, Pauline Chen writes of how useful diagnoses can be in relieving patients’ fears about their symptoms. In doing so, she describes the utility of doctors’ expertise. While the biomedical model is oft critiqued for its cold, objectifying, and even dehumanizing tendencies ( and this is a serious problem), it also trains doctors who have highly specified knowledge that also offers an ability to solve problems that might otherwise be illusive. However, there must be a way to marry some sense of autonomy and humanity with the best that science and medicine have to offer.

Critical Theory and Medical Care in America: Changing Doctor-patient Dynamics

The Comfort of a Diagnosis