For our book Doping in Elite Sports: Voices of French Sportspeople and Their Doctors, 1950-2010 (Routledge, 2018), Christophe Brissonneau interviewed 55 former dopers who competed in a variety of different Olympic sports. At the end of one interview, “Pascal” concluded with a story illustrating the life of an elite cyclist. As he told the story, his face lit up with an expansive smile. One morning during training, Pascal woke up as usual, except he could not move. He was paralyzed. He could not even get out of bed to call his father for help. The next day, Pascal’s father checked in on him and Pascal was still paralyzed in bed. Brissonneau asked what had happened. Through a peel of laughter, Pascal confessed that he had injected himself with a drug a friend gave him, but it turns out the drug was meant for snakes! After the interview, Brissonneau wrote in his research journal that Pascal’s story was extraordinary. Who in their right mind injects themselves with snake medicine they got surreptitiously from a friend and then laughs about almost dying from it?

Brissonneau realized that he and Pascal lived in different worlds. How does an intelligent person come to see something so irrational as injecting yourself with snake medicine as reasonable and even good? Doping in Elite Sports attempts to answer that question by looking at the social process through which top amateur athletes join the elite ranks of sport and the medicalized training regimes they must embrace in order to succeed there. Ultimately, this social process produces professionalized athletes who consider taking a range of pharmacological products that will increase their physical performance as a normal, everyday aspect of “doing the job”. We also discovered that sports medicine’s mission to constantly push the frontiers of human performance has led to the development of performance technologies with applications not only for sports, but also for civilian and military uses.

To understand the process by which people become elite athletes, we draw on the sequential model of deviance employed by Howard Becker (1963) in his classic study of marijuana smokers. Becker theorized a succession of phases through which people adjust their behaviour in relation to changes in their self-perception as users. Similarly, we identified five phases in elite athletes’ professional careers. Their careers begin as amateurs in what we call the “ordinary world” since it is a social space that makes up the lived reality of most people. From the ordinary world, athletes advance to the professional ranks that form an “extraordinary world,” a sort of bubble, disconnected from the social reality that most people share. In each phase, the time that is dedicated to domestic and academic activities decreases in equal proportion to increased time allotted to the exclusive practice of the sport. Primary group actors (families, classmates) become less central to the athlete’s life as those bound to performance (other athletes, sports directors, doctors) become more central.

As athletes advance in their careers, they change doctors in each phase. As amateurs, athletes see a general practitioner to treat pain and injuries (1st phase). But as they advance in their sports, athletes will need more advanced and specialized medical services, so they begin to see a sports doctor (2nd phase), followed by a performance-physiologist (3rd phase), and finally a specialist in biology or biotechnology (4th phase). The cycle concludes with retirement (5th phase) in which athletes may begin to see addiction specialists to help manage their drug use.

As athletes progress through the phases, the norms that guide their beliefs and actions change through contact with other athletes, trainers, and doctors. An understanding of health conceived of as the absence of illness gradually begins to fade as a conception of health synonymous with performance emerges. As athletes move across the career phases and their training intensifies, they begin to use more and stronger medicine. In the first phase when starting their athletic careers, athletes do not use any substances. When they progress into the second phase, athletes start using legal products (vitamins and iron) taken as intramuscular injections. In the third phase, they use corticoids and anabolic steroids “to look after” their hormonal imbalance and “to do their job.” Athletes that reach the fourth phase and decide to break away from the pack in an attempt to become champions begin using peptide hormones, such as erythropoietin (EPO) and human growth hormones (HGH), under the direction of a biotechnologist.

It is not through only the physical but also the mental transformation of the athletes that we can understand the phases of an athlete’s career. Throughout the phases, athletes gradually revise the standards of ethics used to assess their actions. What remains constant throughout is the sport’s scale of values, which includes an expectation of training long, hard hours and enduring tremendous suffering. The products used during the third phase, such as anabolic steroids, are not considered cheating by elite athletes since they are consistent with sports’ scale of values. Anabolic steroids speed up recovery and thus allow an athlete to work harder and suffer more. The products used in the fourth phase, peptide hormones, are far more powerful. Athletes that use these drugs are considered cheaters since they do not respect sports’ scale of values. Peptide hormones endow athletes with performance gains even if they do not work for them and they force other athletes to use those potentially deadly products to remain competitive.

Our key takeaway from Brissonneau’s more than 10 years of ethnographic research is that doping describes a set of practices governed by the logic of the workplace; elite sport. This produces profound misunderstandings for journalists, sponsors, fans, sport governing bodies, and sports doctors, who often frame doping as a moral issue. However, most athletes who are labelled dopers (and their doctors) do not see themselves as cheaters. They see themselves as competitors doing what is a necessary and normal component of their job. Their bodies are machines built for maximal performance. Increased regulation of athletes’ bodies and sanctions can limit doping, but will not remove doping from contemporary medicalized sport. As long as sport is guided by the logic of elite performances and winning, the medical model and pharmacology will remain.

We also conclude from an extensive study of medical talks, scientific articles, and medical symposiums that what has driven research on doping since the 1960s is the development of a new stage in medical research: a medicine of human enhancement. By creating and developing the concept of doping, physicians gained access to the elite sports world. They conducted studies to understand how bodies could be improved, the pathological phenomena that limit the body’s functioning, and they developed new repair techniques. There is then a transfer of medical knowledge between the sports world, the ordinary world, and the military. The sports world provides medical knowledge for the ordinary world on obesity, cardiovascular dysfunction, and cancer, while it provides the military world with knowledge on how to create, as one exercise physiologist told us, “a super soldier who can walk 40 km, with 40 kg on his shoulders, in 40 °c [104 °f] for seven days without sleeping in Afghanistan” as well as how to support human life in space. Ultimately, we agree with other researchers concerned with the “weaponization” of sports knowledge and call for more research into this important topic.

Christophe Brissonneau is a researcher in the sociology department of the University of Paris Descartes, France. His research interests include sociological theory, socialization, deviance, health, and ethics. His recent work has focused on elite sport, its medicalization, and different types of doping careers in France from 1950 to 2000.

Jeffrey Montez de Oca is an Associate Professor in the sociology department at the University of Colorado Colorado Springs, USA. His current research focuses on NFL marketing. His monograph Discipline and Indulgence: College Football, Media, and the American Way of Life During the Cold War won the 2014 North American Society for the Sociology of Sport Outstanding Book Award.