In the Freudian Era, Narcissism was a central psychiatric concept and diagnosis. In the last several months, the likelihood that the American Psychiatric Association will drop this diagnosis from it’s new, 5th edition of The Diagnostic and Statistical Manual of Mental Disorders (DSM) has been the subject of a string of articles in prominent newspapers and other news outlets including the New York Times and NPR. Though the debate is one about professional discourse and diagnosis, it extends well beyond this realm and begs the question of whether or not this change represents a larger trend in the US wherein Americans no longer see putting themselves before others and thinking of themselves as better and more capable than others (even with little evidence to back it up) as a problem.
In her book, Generation Me: Why Today’s Young Americans are More Confident, Assertive, Entitled – and More Miserable than Ever Before, Jean Twenge somewhat satirically describes an increasing focus on the importance of self-esteem in American Society. From birth, she argues, children are steeped in the notion that they are important just for being them and that they must make themselves feel good at all costs. Ultimately, Twenge argues, this rather ironically leads to more unhappiness and even mental illness, as the current generation of young adults does not learn how to live in the real world. Their entire educational experience can be captured by several of Twenge’s examples: children receive trophies just for doing their best, rather than for being the best player or the hardest worker on the team; they are content with C grades because teachers tell them they’re good no matter what their grades are; they earn pretty stickers for effort rather than genuine achievement. While there are some wonderful outcomes of the self-esteem movement (for a description of the functions and theories of self-esteem, see the linked article below) that started with the Baby Boomer generation – namely that kids do feel more liberated and, in moderation, self-esteem is certainly beneficial – Twenge argues that the level of self-esteem present in today’s kids is harmful to both them and society more broadly. Ultimately, over-inflated self-esteem can result in narcissistic tendencies that lead to much more than feeling overly good about oneself; narcissism can ruin relationships, cost people their jobs, and even lead to increases in violence.
The recent uptick in genetic testing for a range of illnesses has prompted great debate in the medical community about how reliable and useful the testing is, as well as discussion among social scientists about the social and ethical consequences of the testing. One line of inquiry that has been around a bit longer is about biological thinking, specifically as it is related to stigma and inequality. In particular, there is a fascinating and timely discussion of the geneticization of mental illness by Jo Phelan (2005) that, even before the emergence of the current debate about technology, delved into the promise and perils of genetic thinking – though not specifically about genetic testing. For instance, Phelan addresses issues of stigma and labeling associated with seeing mental illness as a genetic problem. Phelan finds that stigma is, at the same time, both enhanced and alleviated by geneticization. In other words, if an illness is genetic, it removes the feelings of responsibility from the sufferer and makes it more difficult for others to blame him or her for said illness. The illness and the person who embodies said condition, then, are not seen as one and the same. However, the same genetic thinking opens the door to a range of new judgments that can be detrimental both in terms of self-concept and the way in which others make assumptions about those who experience, in this case, mental illness. There has been some, but not much work, overall, in the social sciences, about the social problems associated with genetic testing (for a lovely summary, see the article linked below). In the last few weeks, genetic testing has been thrust into the forefront once again after fervent debate that ended with Eric Holder, US Attorney General ruling that genes cannot be patented – thus, genes are in the public domain – even though companies like “Myriad,” a testing company, already possess the patent to two human genes (and it is unclear what will happen to these patents).
Drawing on the existent literature on genetic testing, Richard Tutton (whose recent article in Sociology Compass is linked below) reviews the literature on genetic testing and calls for sociologists to pay more attention to these issues. Though Tutton does not address issues of inequality directly, the recent debate on access to genetic testing led me to wonder, for instance, who can afford the testing? Who will it be offered to? Will insurance cover it? How might this testing “blame” ethnic/racial groups for illness? In reference to the Phelan article mentioned above, would knowing one is predestined to developed depression, for instance, change the way we see someone struggling with that condition? And on and on and on. Tutton does survey the literature on the use of genetic testing and forensics and there is clearly an open door to an over-reliance on an imperfect technology when someone’s freedom or life hangs in the balance. One of the great fears about genetic testing is that it will become a central determining factor in whether we see people as “criminal” or not — a frightening idea.
A bill to extend health insurance to millions more Americans and to cut premiums and force coverage for pre-existing conditions for all Americans passed the house this week. President Obama will sign the bill today. At the Eastern Sociological Society conference in Boston this past weekend, I attended a panel on resistance to medicalization where Peter Conrad, who one might call the father of contemporary medicalization theory, presented a new project on the medicalization of chronic pain. The overarching theme of this panel was what seems to me a fascinating potential backlash to medicalization – the desire to keep certain experiences, behaviors, emotions from definition by the medical community. As I listened to the panel last Saturday, I began to wonder, as I have increasingly, whether insuring more people will propel medicalization. In the last several decades, there has been some backlash against or resistance to the dominant conceptualization of things such as depression, ADHD, alcoholism and even childbirth as medical (see the article below), but, if we insure more Americans, which is a great victory for our society, there may be an unintended consequence of maintaining the medical definitions of these and many other conditions, since insurance companies base their decisions to pay for treatment of any condition on whether or not it is a genuine medical/biological illness. If it is, coverage is more likely. If it is not, denial more likely. Therefore, we will now have perhaps an even greater reason to maintain our medical thinking. We want more coverage for ourselves and our fellow citizens. So the question I pose is this: what will happen to medicalization in an America where even greater numbers of Americans feel they need to conceptualize human experience as medical in order to get treatment or relief? If health insurance is easier to come by, will this fuel medicalization because more people will be insured and therefore, as a society, there is a greater push to get things paid for? What does this mean for the future of the human condition – will we come to be seen as nothing more than the bearers of symptoms? Of course, it is equally possible that insuring more people will only make insurance companies attempts NOT to pay for whatever they can get away with more likely, in which case the effects on medicalization could be little to none. We shall soon see. In either case, medicalization is an important area of focus within medical sociology and one that we will likely have renewed interest in as the American health care system is modified, even if the changes are not overarching or particularly radical.
Obama to Sign Health Bill from MSNBC
Medicalization, Natural Childbirth and Birthing Experiences
The New York Times Sunday Magazine featured an article (a preview of a book) by Ethan Watters about the globalization of American concepts of mental illness (linked below). In short, along with our flavored lattes, burgers and GAP jeans, American concepts of illness are spreading across the globe. I would argue they have spread and are relatively well-integrated into the majority of societies’ understandings of a wide range of symptoms. There are very few places untouched by American conceptualizations of mental disorders, particularly those of the American Psychiatric Association. Relatively ignored in this shortened version of Watters’s argument are the contributions of Sociologists of mental health in describing the construction of illness and how illness conceptualizations/categories spread and affect both individuals diagnosed with the myriad psychiatric conditions now considered biological disorders by American Psychiatry as well as cultures and societies more generally once these concepts become commonly accepted.
For decades, sociologists of mental health have focused on the the ways in which certain symptoms come to be classified as disorders and how psychiatry has become the discipline considered to be the legitimate conceptualizers of these conditions. Allan Horwitz, for example, has been particularly influential in this debate (see the article below). Medications for treating these illnesses are also centrally implicated in these illness definitions. Further, as mentioned in the Times article, though not attributed to sociological research, sociologists have also noted the complex question of whether American criteria for psychiatric illness are being used to diagnose illness across the globe where it had been previously been ignored or whether these criteria are in fact creating illness where it did not exist before by providing cultures previously unexposed to knowledge of, for instance, depression symptomatology. In other words, are we exposing illness where it had been previously been ignored or are we creating illness by imposing our illness categories on societies where the same symptoms we see in the US were not around until our categories hit the scene?
By Dena T. Smith
Part of MSNBC’s lineup includes an hour-long daytime show hosted by the physician, Dr. Nancy. In a segment of her show on Monday, August 31st, she hosted a panel to address the “war on fat people.” Panel members discussed topics such as the etiology of obesity and how the obese are treated in the US. Articles of a similar nature have appeared elsewhere, including the one below, which was featured in a recent edition of Newsweek. Overweight Americans have long been a target of criticism and mockery and even as other behaviors, addictions and illnesses have been at least partly de-stigmatized, obesity seems to be left in the cold. In other words, the discussion surrounding obesity has a similar tone to debates over other conditions and/or illnesses that are under scrutiny both in American society and globally. The tension is about the attribution of blame and the pendulum swings back and forth between personal responsibility and genetic predisposition. Who or what do we blame for obesity, depression, diabetes, addiction, etc.? How do we assign responsibility for the existence of illnesses when there is evidence that biology and lifestyle, environment, culture and elements of the social structure of a society impact said condition? Of late, most mental illness (both “milder” afflictions such as depression and anxiety as well as more severely impairing conditions like schizophrenia), and physical illness are attributed to problems in biology or chemical imbalances. However, when it comes to obesity, Americans are quite reluctant to accept the biological blame game and this is highly consequential for the way in which overweight individuals are seen and understand themselves and their experiences.