The Social Construction of Illness: Key Insights and Policy Implications Author(s): Peter Conrad and Kristin K.

Barker Source: Journal of Health and Social Behavior, Vol. 51, Extra Issue: What Do We Know? Key Findings from 50 Years of Medical Sociology (2010), pp. S67-S79 Published by: American Sociological Association Stable URL: http://www.jstor.org/stable/20798317 . Accessed: 04/08/2013 19:52
Your use of the JSTOR archive indicates your acceptance of the Terms & Conditions of Use, available at . http://www.jstor.org/page/info/about/policies/terms.jsp

.
JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship. For more information about JSTOR, please contact support@jstor.org.

American Sociological Association is collaborating with JSTOR to digitize, preserve and extend access to Journal of Health and Social Behavior.

http://www.jstor.org

This content downloaded from 128.122.149.145 on Sun, 4 Aug 2013 19:52:07 PM All use subject to JSTOR Terms and Conditions

AMERICAN SOCIOLOGICAL ASSOCIATION of Health and Social Behavior Journal 51 (S) S67-S79 ?American Sociological Association 2010 DOI: 10.1 177/0022146510383495 http://jhsb.sagepub.com

The

Social

Construction

of

Illness: Key Insights and Policy

Implications
Peter Conrad1 and Kristin K. Barker2

(?)SAGE

Abstract The construction inmedical of illness is a major research perspective article traces sociology.This of this perspective and presents three overarching constructionist illnesses findings. First, some are particularly embedded is not directly derived with cultural meaning?which from the nature of the to those afflicted and influences the experience condition?that of that shapes how society responds social the roots illness. Second, come all illnesses and to understand are socially constructed livewith their illness.Third, and at the experiential medical knowledge level, based about on how individuals is not illness and disease

given by nature but is constructed necessarily We address central policy implications of each in a social constructionist relevant research to medicine's counterpoint broaden policy deliberations largely deterministic and decisions.

and interested parties. developed by claims-makers of these findings and discuss fruitful directions for policy an important constructionism tradition. Social provides approaches to disease and illness, and it can help us

Keywords social construction, illness, medical knowledge, health policy

In

the

last has

illness subfield nificant social briefly approach

the social construction of years, a major area in the research of medical and it has made sociology, sig to our understanding contributions of the 50 become of illness. of a In social this article we the roots constructionist

groups reality 1966). A is rooted

contribute and

to producing social perceived and Luckman knowledge (Berger to illness social constructionist approach in the widely recognized conceptual dis

dimensions trace

present some of the key of social constructionism findings organized under three themes: the cultural meaning of illness, the as socially constructed, and med illness experience as socially constructed. In addition, ical knowledge we address central policy of these implications findings research Social work and fruitful directions in a social constructionist for policy-relevant tradition.

to illness, and we

tinction between disease (thebiological condition) and illness (the social meaning of the condition) (Eisenberg 1977). Although there are criticisms
and useful model, and limitations 2008),1 of this distinction and Haas it is nevertheless (Timmermans an exceedingly In contrast to the medical are universal

tool. conceptual assumes which that diseases

to time or place, social construction how the meaning and experience of ists emphasize illness is shaped by cultural and social systems. In invariant

constructionism is a conceptual frame that emphasizes the cultural and historical aspects of phenomena widely thought to be exclu is on how meanings sively natural. The emphasis of phenomena do not necessarily inhere in the

'Brandeis University 2Oregon State University Author: Corresponding Peter Conrad, Department of Sociology, Brandeis 10 University,Waltham, MA 02454-91 E-mail: Conrad@brandeis.edu

themselves but develop phenomena through inter action in a social context. Put another way, social constructionism examines how individuals and

This content downloaded from 128.122.149.145 on Sun, 4 Aug 2013 19:52:07 PM All use subject to JSTOR Terms and Conditions

S68

JournalofHealth and Social Behavior 51 (S)

to the social

or physicians. As ing tobe discoveredby scientists Gusfield (1967) notes, "Illness is a social designa fact" (p. 180). There are, of course,biophysiologi cal bodily conditionsor naturallyoccurringevents, but these aren't ipso facto illnesses.Neither are they ipso facto diseases. The disease side of the disease/illness conceptual distinction is also ripe
for social constructionist tion, by no means given in the nature of medical

short, illness

is not simply present

in nature, wait

of patienthood, as distinctfrom any biological condition that may (or may not) launch such a individuals actively participate in interactionists, own socialworlds, includ of their theconstruction via ongoing social of the construction selfhood, ing interaction (Blumer 1969). The key tenetsof sym bolic interactionism effectivelylent themselvesto a detailed exploration of illness as experienced within the context of daily social interactions, which in turn alter the performance of self (Charmaz 1991; Glaser and Strauss 1965). In a related fashion,phenomenological tenets (Berger and Luckmann 1966; Schutz 1967)were appropri ated by medical sociologists to showcase how make sense of their illness,how they individuals and how with cope physical and social restrictions, in restric the face of those deflect self-erosion they tions (Bury 1982). Eliot Freidson's (1970) paradigm-shifting Medicine, also laid important book, Profession of of illness groundworkfor the social construction partof thebook, ina section approach. In the latter titled "The Social Construction of Illness," Freidson (1970) explains how illnesseshave con fromanybiological effects: sequences independent
[W]hen a physician diagnoses a human's condi tion as illness, he [sic] changes the man's [sic] behavior by diagnosis; a social state is added to a state by assigning themeaning biophysiological of illness to disease. It is in this sense that the phy sicians creates illness . . . and that illness is . . . analytically disease, and empirically distinct from mere career. According to Goffman and other symbolic

career,"

Goffman

spoke

experiences

gets labeled a disease or qualifies as biological is often sociallynegotiated.

analysis,

insofar as what

THE ORIGINS OF SOCIAL CONSTRUCTIONISM

There are multiple intellectualroots of a social
constructionist approach to illness.

Some of thebasic building blocks are evident in the (e.g., writings of early sociological thinkers Emile Durkheim, Karl Mannheim, and W. I. Thomas), butwe will startthe story in the 1960s with themore direct predecessors of, and early
contributors to, the social construction of illness.

most important founda intellectual One of the of illness is social tionsof the social construction and research fromthe 1960s and problems theory
from positivist inter themselves 1970s. Distancing that in this tradition asserted scholars pretations, or what comes to be identified as deviant behavior a social

within a particular social context and in ferred

response "moral to successful entrepreneurialism" "claims-making" social by and groups

problem

is not "given,"

but rather is con

(Becker 1963; Gusfield 1967, 1975; Spector and Kitsuse 1977). These scholarsalso emphasized the
intentional of social use control for the purpose of these categories (i.e., defining and enforcing how

(p. 223)

particular people ought tobehave). The basic tenets of this framework have been readilyapplied to ill ness. Specifically, medical sociologistspoint to the processes by which certain behaviors contingent and experiencescome tobe definedasmedical con can function ditions,and the way thosedefinitions as a typeof social control (Conrad and Schneider 1992;Zola 1972). two popular and overlapping intellectualtrendsin contrib sociology in the 1960s?also significantly
uted to a social constructionist Symbolic interactionism and phenomenology?

Not only did Freidson (1970) explicitlyrecog nize the real and tangible social consequences of an illness label, but he also urged sociologists to address "how signs or symptoms get tobe labeled or diagnosed as an illness in the first place" (p. 212). By arguing that illness and disease, like
deviance, evaluative what are social constructions based on categories (i.e., they are social ideas about Freidson

foreshadowedthe subsequentsociological studyof

medical

is not "acceptable"

or "desirable"),

The writings ofMichel Foucault (1977) and albeit in a dif work in theFoucauldian tradition,
ferent vein, cal also knowledge, the scrutiny of medi emphasized in so doing, contributed and, to a social construction of illness regarded knowledge as a form

categories

and knowledge.

ErvingGoffman's (1961, 1963) earlywork helped to shape the symbolic interactionisttradition.

Through his conceptualization of the "moral

approach

to illness.

approach.

significantly Foucault

This content downloaded from 128.122.149.145 on Sun, 4 Aug 2013 19:52:07 PM All use subject to JSTOR Terms and Conditions

Conrad and Barker

S69

of power. Specifically, he argued that expert mality,"which is not objective or naturallygiven, modern societies: is theprincipal formof power in hence, his oft quoted expression, "knowledge/ constructsknowledge about the body, including disease.As Bryan Turner (1995) notes, "We can no longer regard diseases as natural events in the world which occur outside the language inwhich theyare described.A disease entityis theproduct medical of medical discourses" (p. 11). In turn,
discourse can influence power." Foucault stressed how medical discourse knowledge about human "normality" and "abnor

are common inour societyand significantly impact with the disease. Similarly,Barry those afflicted et al. (2009) examined how obesitymetaphors, affect indi such as "obesity as sinful" (gluttony), viduals' supportfordifferent public policies aimed at reducingobesity. While sociologists have rarelyfocused on the metaphorical connotations of illness, they have examined the impact of other cultural meanings all illnessesare embedded in illness. In thisregard,
not the same. For matized, instance, some illnesses are stig and others are not; some are contested, and disabilities,

their subjective experiences of embodiment, shape their identities, and legitimatemedical interventions (Foucault 1975, 1977).Accordingly, knowledge (i.e., provide a detailed analysis of medical discourse) to reveal its embeddedmean ings,normalizing tendencies,and relationship to embodiment and identity(Barker 1998; Lupton 1997;Rose 2006).
This Foucault-inspired scholars deconstruct medical

people's

behaviors,

impact

about these What is important while othersare not. distinctionsis thattheyexist for social ratherthan
purely

others are not; and some are considered

in examining thesedis gists are keenly interested because theybring into sharp relief the tinctions
cultural landscape that ordinarily eludes us; or, as

biological

reasons. As we will

see,

sociolo

the intellectualstrands that lead up to, and con

constructionist approach these strands are not mutually on draw medical exclusive. sociologists Many various aspects of these different traditions. As we of we the social construction consider proceed, as something of an amalgam. illness approach tinue to illness. Moreover, various types of social constructionism, to inform, a social

is by no means

an exhaustive

account

of

the anthropologistRalph Linton (1936) once would notice is water." fish quipped, "The lastthing mere sociological curiosities,these But more than cultural meanings have an impacton theway the illness is experienced,how the illness is depicted, the social response to the illness,andwhat policies
are created

Here, one key line of sociological research is

that which matized considers illnesses. Drawing of stig the cultural meaning on the work of illness" as a cat

concerning

the illness.

Although this minimizes importantdifferences

between it

Goffman, Gussow and Tracy (1968) were the

first to distinguish researchers mental sexually researchers

mere

can be justified in thattheyall share an eschewal of a strictly positivist conception of illness as the
embodiment shared of disease. The

egory using the case of leprosy. Subsequent

examined the construction and impact

"stigmatized

of a number of stigmatized illnesses, including

illness, epilepsy, cancer, diseases how HIV/AIDS, (STDs). some and transmitted have These illnesses

foregrounds how
interactions, frameworks

illness is shaped by social

cultural traditions, and relations shifting of power.

approach

identified

of knowledge,

become stigmatized, the impacts of stigma, the

ways collectivities and individuals manage can change over stigma, and how illness stigma in the has time. For example, research shown, sufferers to manage the stigma than the seizures

KEY FINDINGS OF SOCIAL CONSTRUCTIONISM

Cultural Meanings of Illness
Illnesses have both biomedicai and experiential dimensions. Although oftenunnoticedor takenfor
granted, certain illnesses have cultural meanings dent have attributed on social particular to them. These mean or

case of epilepsy, that it can be more difficultfor (Schneider and Conrad 1983; Scambler 1989). In the case ofHIV/AIDS, other researchhas shown and affects how stigma limitsaccess to treatment and identity(Epstein 1996;Weitz relationships from a constructioniststand The lesson 1990). is nothing inherentabout a that there is point makes it stigmatizing;rather,it is condition that the social response to the condition and some of make a condition stigmatized sufferfrom it, that (Conrad 1987).
its manifestations, or the type of individuals who

ings adhere to the illness and may have indepen

consequences patients and health care.

Cultural analystspoint out that illnesses also may (1978), for example, argued thatnegative meta
phorical meanings of cancer, as evil or repressive, metaphorical connotations. Susan Sontag

This content downloaded from 128.122.149.145 on Sun, 4 Aug 2013 19:52:07 PM All use subject to JSTOR Terms and Conditions

S70

JournalofHealth and Social Behavior 5I(S)

Contested These

illnesses are

have a very particularcultural that, by definition,

meaning. illnesses where sufferers claim

are a category

of disorders

of theCultural Meaning PolicyImplications Illness of

As we have

to have a specificdisease that many physiciansdo medical. not recognizeor acknowledge as distinctly Contested illnesses, includingchronic fatigue syn irritable bowel syn drome,fibromyalgiasyndrome, chemical and drome, sensitivity are multiple
suspect because the they are not associated between lay

medically nesses

These ill with any known physical abnormality.

showcase tension and

cultural meanings thatare not reducible tobiology, burden the and these culturalmeanings further At a general level, insights from this line afflicted. of research suggest a shiftin emphasis away from an exclusive focus on biomedically fixing indi
viduals and toward

noted,

certain

illnesses

come

to have

medical knowledge with respect to the cultural legitimationof symptoms and suffering.In the
words of one

tural context that gives particular illnesses their

negative

changing

the social

and

cul

have tofightto get" (Dumit 2006). Physicians, the of the symptomsand the question the authenticity In sum, contested of the sufferer. mental stability
illness sufferers are burdened public, and sometimes even sufferers themselves

researcher,

these are "illness[es]

you

For example, thereare policy implicationsof both stigmatizedillnessand contested illness.Stig

illness can make an illness much more

meaning.

matized

ingof a medically invisiblecondition in an era of biomedicine (Barker2005; Brown 2007; high-tech becomes Kroll-Smithand Floyd 1997). In fact,this one of the most important of these characteristics
illnesses, care, to a diagnosis and health affecting access and the response of others to one's problem, describing the social construction of

by the cultural mean

difficultto treatand manage. For example, if an illness such as epilepsy orHIV/AIDS has a power ful stigma, it can make people less likely to seek treatment for fear of being mistreated by health care providers and publicly associated with a taintedcondition.Obese women reportavoiding routine gynecological exams, despite having
than non of obesity cancers higher rates of gynecological obese women, because of the stigma

of the sufferer. thevery identity

Research

and thecorresponding negative attitudesof health careprofessionalstoward overweight people (Amy, effectivepolicy based on early cancer screening
overcome this barrier. are not associated Lyons, and Keranen 2006). Therefore, an

disabilityalso provides a powerful example of the of this approach are found inGoffman's (1963)
Stigma, physical social wherein the social meaning he highlights comes to acquire via social impairment of impairment does not emanate cultural meaning of certain conditions. The roots

Aalborg, must

In the case of contested illnesses, the fact that

sufferers'

Goffman claims thatthe interactions. Specifically,

meaning

with a discernable biomedicai abnormalityoften makes itdifficult for themto have theirsymptoms
or treated, and often raises suspicions acknowledged are "all in their heads." that their problems Some physicians contested will to treat patients diagnosed with illnesses, and some insurance companies refuse for such treatment. On the other

symptoms

readily

but from the fabricof fromthe impairment itself, everyday life. The social model of disability,
grounded on social constructionist

(i.e., the attribute) tuallydistinguishes impairment from disability (i.e., the social experience and
of

tenets, concep

not reimburse

hand,

meaning

thatare deemed disabilities,and theverymeaning

disabled, vary across time and space, dis

impairment).

Because

the attributes

ability cannot be reduced to a mere biological problem located in an individual's body (Barnes, most basic Mercer, and Shakespeare 1999). In its form,thisdistinctionsuggests thatthebody has an impairment (e.g., loss of limb)while society cre ates the disability (Oliver 1996). Rather than a
"personal tragedy" that should be fixed to conform to medically determined standards of "normality" questions How then emerge. What obstacles

of being

costlydiagnosticprocedures.Faced with this situ ation, health organizationsmay find thatgiving patientsa contested illnessdiagnosis and providing them with inexpensive palliatives is the most
effective means of cost containment. Conse there are real concerns that these diag quently, noses are being overused to manage difficult and

as desires for a medical patients' diagnosis confirmation that their symptoms are "real" often lead to excessive for unnecessary demand and

(Zola 1982), disabilitybecomes politicized. New

limit the

potentiallyexpensive patients (Barker2005). This may be one factorbehind thegrowingprevalence

of contested spread arenas of illnesses. Another Internet support may groups be the rise and as alternative Despite sufferers the of

opportunitiesfor individualswith impairments?

can those obstacles be altered or removed?

for legitimating such illnesses. use of these widespread diagnoses,

This content downloaded from 128.122.149.145 on Sun, 4 Aug 2013 19:52:07 PM All use subject to JSTOR Terms and Conditions

Conrad and Barker

S71

contested

illnesses

meet the stated bility benefits, even when they criteria regarding the inability to do "usual and under find solutionsfortheputativeproblems that
lie contested illnesses are also scarce relative to the are customary work." Funds for medical research to

only

infrequently

receive

disa

number of individuals afflicted.In each of these

areas, effective medical

likely to be enhanced by a greaterappreciationof

consequences of cultural meanings

practice

and

policy

the behavioral

that of some suf grant legitimacyto the symptoms

ferers and not to those of others.

discovered, but rather is created by individuals who act in and toward their world. Applied to ill with ness, people enact theirillness and endow it are to not entities merely passive meaning. They whom thingsare done (be it by a disease or by doctors and treatments). This is thegeneral starting a number of linesof sociologi for point important cal research, all highlighting the everyday and subjectiveexperienceof illness. In the 1960s, sociologists began to study the
patient's

The policy insightsderived from the social

construction

Passed in 1990, theAmericans with Disabilities Act (ADA) affirms theessence of social construc
tionist

of disability

approach

are

myriad.

ment need not be disabling when societymakes

reasonable

claims?namely,

an

individual's as

impair

allow wheelchair access into Although a buildings. individuals for civil living rightsvictory symbolic ADA of the with disabilities, the legal limitations arewell known (Acemoglu andAngrist 2001; Lee 2001). Moreover, theADA primarily addresses workplace discrimination and issues of public
access,

accommodations,

such

ramps

to

Strauss 1965;Goffman 1961). Strauss and his col leagues (Strauss and Glaser 1975), however,were among thefirstto recognize thatthepatientexperi ence isnot the same as the illnessexperience; after all, people with illnesses spend very littletime in thepatient role.This important step laid a founda tion fora more developed approach to the experi ence of illness.Building on this tradition, Conrad the elaborated (1987) approach:
[A] sociology of illness experience must consider everyday lives living with and in spite of

perspective

of

illness

(e.g.,

Glaser

and

people's

senta fundamental shiftin thecultural meaning of The social constructionist perspective disability. helps make sense of many other policy debates, includingthe opposition ofmany members of the
deaf

which,

although

important,

do not

repre

illness. It needs to be based on systematically col lected and analyzed data from a sufficient number and variety of people with an illness. Such a perspec tive necessarily focuses on themeaning strategies used in adaptation, (pp. 4-5) of illness, the social organization of the sufferer'sworld, and

hope the implant ple,while parentsof deaf children will make theirchildrenas normal as possible by giving themat least some ability to hear, thedeaf with itsown language defectbut a cultural identity undermine thatidentity and thatimplants (Dolnick explainwhy some disability rightsadvocates part
ways with 1993). Social constructionist tenets on policies also help community contends that deafness is not a medical

community

to cochlear

implants.

For

exam

inter This research isusually based on in-depth on the illness views, focusing experi subjective
ence and

perspective is well positioned to examine how

individuals construct and manage The their illness, and with what

creating

an

"insider's"

view.

Such

(1991) is a well-developed example. Charmaz describes how the worlds of some individuals
shrink when aspects become they are of managing immersed a chronic in the day-to-day illness. They

consequences.

research

of Charmaz

ingdeathwith dignityand prenatalgenetic screen movement ing and selection.The disability rights oftenopposes the cultural messages behind these
and procedures?namely, that it's better to

other progressives

concern

conventional

policies

be dead (or not born at all) thandisabled.

Illness Experience as Socially Constructed is thatthe of constructionism Another key insight

illness unde

ormove about with family,socialize with friends, Thus, the foundationon which a sense of freely. self is based can be lost, there is nothing to look forwardto,and nothing to do; time is experienced as unchanging (Charmaz 1991). There are also a numberof studies thatclosely
examine

cut off from the routines of increasingly to work, time life?unable spend

assertion is grounded in the strong pragmatist nomenology,which suggest that realitydoes not just exist out there in theworld waiting to be
innings of symbolic interactionism and phe

experience

is

socially

constructed.

This

as HIV/AIDS (Klitzman and Beyer 2003; Weitz McMurry, and Hedges 1990), diabetes (Peyrot, asthma (Snadden and Brown 1992), and 1987), fibromyalgia(Barker2005). Schneider andConrad (1983), forexample, provide a detailed account of

the experience

of specific

illnesses

such

This content downloaded from 128.122.149.145 on Sun, 4 Aug 2013 19:52:07 PM All use subject to JSTOR Terms and Conditions

S72

JournalofHealth and Social Behavior 51 (S)

the experiences of individuals with epilepsy, includingthe ins and outs ofwhen, and towhom, about theirill theyreveal or conceal information
ness. From

illness experience.Even in illness individualsare not passive: "the self ismore than its body and much more thanan illness" (Charmaz 1991:258).

ing intimate relationships, to going on a job or being on the lookoutfor"safe places" interview with epilepsy tryto to have seizures, individuals
maintain

getting

a driver's

license

and negotiat

as of Illness Experience PolicyImplications

Socially Constructed The key research findings concerning the social
construction of the illness

crimination,and avoid becoming the object of a Whether focusing on chronic illness public crisis. are the types of rich details that emerge from research intothe illness experience. This researchalso describes how people strug gle tomake sense of their illness and reclaim a
in general, or on a specific chronic illness, these

self-control,

skirt embarrassment

and dis have a num

ber of criticalpolicy implications.First, some of on clinical perspec thesefindingsshed a new light pliance" (Conrad 1985; Peyrot et al. 1987) and the impact of the subjective perspective on interac
tions with medical tives and policies toward issues such as "noncom

experience

sense of self.People endeavor to endow theirill ness withmeaning within the contextof their per
sonal health beliefs, and social relationships, coverage, employment and abate status, cultural an ero insurance and religious the like. Individuals may

(Waitzkin 1991). The focus on themeanings of medications in the contextof a patient's everyday orders, allows the clinical policy focus to shift ofmedi to improve the effectiveimplementation cal regimens.By giving voice to the sufferers' perspective,theexperienceof illnessapproach can Take thecase of clinical reforms. lead to important
its vast technical arse Despite pain management. to see or measure is simply unable nal, medicine have often trivial pain. For this reason, physicians from "compliance" to context-centered strategies life, rather than on compliance with doctors'

professionals

and

care-givers

reconstruction. sion of selfby engaging in identity Said differently, when illness becomes a "bio graphical disruption," individuals recast them selves in terms of new and unexpected plot developments (Bury 1982). Chronic illness can
a re-evaluation in some (e.g., of one's cases, cancer former life and of a new Finally, identity, and, illness the creation survivor).

prompt

medical sociologists have documented how lay people sometimes create and join illness-based
social movements, their own medical generate conditions,

identity

who lack a visible injury ized thepain of patients to account for their suffering. More aggressive
may management we take seriously sufferers. of evaluating The be mandated, however, appropriate of chronic in narrative the first develop the vivid accounts current interest were and

munities based on illness identities (Banks and Prior 2001; Brown et al. 2004; Kroll-Smith and Floyd 1997). Millions of American women, for
example,

about lay knowledge and forge new com

pain once means pain

work of medicine is in largepartpredicated on the

sociologists dow and others who

activists in the fight against breast cancer. They events, options,participate innational fundraising and mobilize in supportof relevantpolicies and initiatives(Klawiter 2008; Radin 2006). In sum, individualsactively shape theparametersof their illnessand the meaning of selfhood in relationship This line of researchbrings to the fore aspects of illness thatthe tools ofmedicine are unable to
reveal. A constructionist and social to those parameters. exchange information about their treatment

identify as breast

cancer

survivors

and

to listen to illness stories (Frank 1995).As a win

into subjective illness narratives experience, of bringing the person used as a means

among

are now

back into and for medicine, both as an end in itself chronic benefits. pain Again, potential therapeutic is illustrative: When it comes to affirmingthe and authenticatingthe humanity of the sufferer
existence

jective experience of illness seriously,examining exploring how illness is managed in the social
contexts that sufferers inhabit. This research has the personal meanings of illness, and

approach

takes

the sub

of high-tech medicine overcoming the limitations (Kleinman 1988). There are also policy and clinical implications
associated with the constructionist

of pain,

patient

narratives

are a tool for

more

With the ing lay knowledge and illness identities. expansion of the Internet, laypeople are becoming ingknowledge about theirown health conditions; they are also increasingly likely to create and
actively involved in producing and consum

findings

regard

view of thesuffer given us a detailed and intimate that illness often but it has also represents, ing
shown us that agency and resistance are key to the

embrace

new

illness

identities.

Some

medical

This content downloaded from 128.122.149.145 on Sun, 4 Aug 2013 19:52:07 PM All use subject to JSTOR Terms and Conditions

Conrad and Barker

S73

ways of knowing may sociologists suggest thatlay medical supplement knowledge and positively influencehealth outcomes (Brown 1992; Kroll Smith and Floyd 1997). Illness identities might also contributeto improved well-being insofaras a formof self-empowerment (Popay theyrepresent
and Williams

discourse

and

to naturalize gender inequality (Clarke 1998; Ehrenreich and English 1978; Lorber 1997). For example, embedded within medical knowledge about pregnancy,premenstrualsyndrome (PMS), and menopause, one finds clear ideas childbirth,
(i.e., subordinate) "proper" place as moral in society, as well about assumptions women's sexuality and femininity more generally. In the early twentieth century, pregnant women about women's

practice,

and,

in

turn, functions

sons to be concerned that lay knowledge and ill ness identities may negativelyimpact doctor-patient to theexpansion ofmedicalization (Fox, Ward, and O'Rourke 2005; Hardey 1999). For better or worse, layand experiential knowledgewill increas come with and challenge profes into conflict ingly sional knowledge. This is all themore assured medicine's mixed recordof thera given orthodox peutic efficacy in the face of many chronic ill
nesses. relationships and health outcomes and contribute

1996).

However,

there are also

rea

were advised against driving an automobile or dancing,on grounds thattheseactivities threatened unborn child. Today, pregnant thehealth of their women are endlesslywarned about the risks of 2003). In both peri drinkingalcohol (Armstrong marked cultural ods, themedical advice reflects
anxieties about women's sexual and social

conflicts and themovements they engenderwill create major policy challenges. Medical Knowledge as Socially Constructed medi Eliot Freidson (1970) was probably thefirst howmedical knowledge cal sociologist toarticulate tists have takenseveraldifferent paths in the study ofmedical knowledge. of the social construction
One major cal knowledge line of research sometimes some exposes and how medi reproduces reflects is socially constructed. Over the years, social scien

Coming

to terms with

these

lay-medical

freedoms; and, in both periods, when pregnant women follow theprescribed medical advice, they enact the dominant cultural ideals of femininity. Medical knowledge about PMS provides another
interesting symptoms case. Precisely of PMS (e.g., because frustration, some of the aggression,

anger) defy norms about how women ought to behave, theybecome prima facie evidence of a disorder (Markens 1996). Thus, not only canmed ical ideas result in the social control ofwomen's behavior, but theyalso contributeto our cultural beliefs concerningtheexistence of unalterabledif
ferences between men and women. These

existing forms of social inequality.Rather than or explicitly,shores up the interests of implicitly those groups in power. Upon close inspection,
value-neutral, medical knowledge,

being

in turn,can be used to justifygender inequality within intimate families, institutions, relationships,

and

beliefs,

The research of medical sociologists in the

subfield of science studies also reveals how medi

society.

some medical shown to support ideas have been inequality. For the gender, class, and racial-ethnic some sake of illustration, we present important

to thisundertaking. feminist contributions

Feminists have found the social

construction

of

illnessapproach tobe a particularly potentanalytic of thestrong is likelytheresult device. This affinity constructionisttendencywithin feminist theory most (butnot more generally. The starting point for the is feminist conceptual distinction theory all)
between that our

cal knowledge is conditionedby the social context in which it is developed. Specifically, these schol ars explain that what qualifies as biological disease or biomedicai evidence is oftensociallynegotiated and interpreted (Joyce 2008; Timmermans 2007). Steven Epstein's work is exemplaryof this typeof research. In a recentbook Epstein (2007) analyzes the emergence,beginning in the mid-1980s, of a
new

mean der is a social construction, by which they

ideas about

gender

and

sex. Feminists

claim

that gen

tively included individualsfromunderrepresented

social

paradigm groups

of biomedicai (e.g., women

research and racial

that proac and ethnic

andmasculinity) arenot ards concerning femininity our by biological sex differences. predetermined our about ideas Therefore, gender and the social
that they institutionalize practices A number of feminist scholars are alterable. have shown how

gender

(i.e., norms

and

stand

with an eye toward minorities) in clinical studies, the between differences groupswith understanding
and treatment out to disease processes respect comes. Even as this new paradigm offers potential why do black women the consequence

tools foraddressingnaggingquestions abouthealth

with breast

gendermeaning is inscribedontowomen's bodies and minds through past and present medical

disparities?e.g.,

white cancer have higher mortalityrates thantheir

counterparts??it has of reifying

This content downloaded from 128.122.149.145 on Sun, 4 Aug 2013 19:52:07 PM All use subject to JSTOR Terms and Conditions

S74 the categories of race and gender as biological realities. But, by showcasinghow a numberof dif ferent interestgroups and institutional players
(e.g., feminist activists, and advocates various for racial and minority groups, cadres of bureau

JournalofHealth and Social Behavior 5I(S)

medicine, especially the pharmaceutical industry, are increasinglyimportant in the shaping and dis of medical knowledge topromote their seminating female sexual dysfunction(Hartley2006), meno pause (Bell 1990),mild depression (Horwitz and Wakefield 2007), sleep disorders (Williams 2005), and many other problems. The case of erectile dysfunctionis telling(Loe 2004). In the late 1990s
male products. There are now important case studies on

crats) pushed for this new research paradigm, Epstein explains how the knowledge it produces about race and gender are in part theoutcome of social and political conflictsand negotiations,as
opposed to essential truths found in nature. In an

underscored earlierbook, Epstein (1996) similarly how the politics of knowledge by demonstrating of the science regardingthe cause and treatment HIV/AIDS is best understood as an amalgam that
was constructed (e.g., and contested by different con stituencies scientists, doctors, drug compa rather than the outcome theme of the social con

tion" (ED), and in 1998 theFDA approvedViagra The drugwas intendedforolder for its treatment. men with chronic erectile problems and forED
associated medical with prostate conditions. cancer, diabetes, and other Pfizer, the drug manufacturer, commercials as

impotence

was

renamed

"erectile

dysfunc

soon began promoting the drug to a much larger

audience. Pfizer

nies, patients, of "pure" science. Also under

and activists) the general

virile and relativelyyoung professional athletes,

presented regardless Viagra of age. When any man, benefiting newer competitor drugs

Using

television

featuring

ofmedical knowledge is the influential struction

work when on medicalization. human problems Medicalization or experiences occurs become

defined as medical problems, usually in termsof medicalization emphasize the ologistswho study a particulardiagnosis is devel which processes by becomes accepted as medically valid, and oped, types Sociologists have describedmany different have come tobe of problems and experiences that
defined focused medically. Early on the medicalization of deviance, drug and alcohol behavior (Conrad natural and treated studies includ gets used to define and treat patients' problems. illnesses, diseases, or syndromes. In general, soci

such as Cialis and Levitra came on the scene they were widely advertised as not only treating ED, but as useful for anyone who worried about or wanted to enhance their(or their partner's) sexual Both theboundaries of theED diagnosis and the markets for ED drugs expanded enormously (Conrad 2007). Policy Implications ofMedical Socially Constructed Knowledge as
experience (e.g., "Cialis is ready when you are").

ing madness, homosexual that women's pregnancy,

and problems, and Schneider functions

1992). Over the years, sociologists have shown

reproductive childbirth, menstruation) (e.g., are routinely

medicalized (Barker 1998;Riessman 1983; Riska 2003). For example, Prempro,a widely prescribed hormone replacement drug, is just the latest in the
ongoing effort "symptoms," despite ated with menopause aspect of women's In recent years to medically "treat" menopausal the fact that changes associ are a common reproductive sociologists as lives. have focused on the and ordinary

A numberof policy implicationsare derived from thekey findingsconcerningthe social construction of medical knowledge. By acknowledging that medical knowledge about disease and illness is
other and by socially situated claims-makers interested parties, we can bring greater criti to the policy-making cal awareness process. After constructed

all, anypolicy response to a problem isdetermined by how the problem is defined or framed in the
first place. For

medicalization of ordinary life events,risk, and

"proto e.g., illnesses," and as well individuals' shortcomings improved their desire perceived for enhancements, (Conrad 2007).

problem of health disparities between racial and ethnic groups?When the solution is tomandate thatfederallyfundedclinical studies include indi
viduals from inadvertently and underrepresented cast the problem as we subgroups, in bio rooted struc as a dis

example,

how

do we

approach

the

sexual

Likewise, the engines of medicalization have

expanded movements, consumers, increasing professionals, beyond to biotechnology, and organizations is and the insurance industry. There evidence that commercial aspects of medical social

performance

logical differences between racial and ethnic

groups

turedinequalities(Epstein 2007).
Likewise, when we define the dominant alcoholic,

downplay

the role

of

socially

alcoholism

ease, vidual

is to treat the indi approach rather than examine the social

This content downloaded from 128.122.149.145 on Sun, 4 Aug 2013 19:52:07 PM All use subject to JSTOR Terms and Conditions

Conrad and Barker

S75

to alcohol abuse or therole of factorscontributing the alcohol industryin alcohol promotion. When medical perspectives increasinglydefine obesity as an illness (ratherthana risk factorfordiseases
such as

more skepticalof quick,medicalized fixes for what Finally, medicalization itself raises concerns about the possibility of meaningful health care
reform. are really complex, multifaceted social problems.

policies focus on solutions such as gastricbypass or the availability promotionby the food industry with high rates of healthy foods inneighborhoods the of fetalalco about risks of obesity.2 Warnings women individual hol syndrome blame effectively
and deflect attention surgeries, rather than examining the role of product

diabetes,

cardiovascular

disease,

etc.),

medical problems that are subject to potential

insurance

Creating

an

ever

larger

jurisdiction

of

ous impedimentto providing comprehensive and

universal hensive the case health coverage care coverage. What is compre as medi in in the context of "elective" surgery or of the successful medicine, anti-aging

or public

reimbursement

may

be a seri

commercialization of cosmetic

lished linksamong class, race, and birthoutcomes (Armstrong2003). Framing anger inwomen as with evidence of the disease PMS, to be treated antidepressants,trivializes the impact of gender inequalityonwomen's daily lives.And when dif ficulties in children's attentionand behavior get disorder deficithyperactivity defined as attention school encourage (ADHD), policies increasingly
the use of medication fail to address of children's such as and

away

from

the well-estab

cine? Is itpossible to provide universal coverage given our cultural predisposition for "a pill for every ill," amplifiedby thepharmaceutical indus try'spromotionof an "ill for everypill" (Mintzes what can be 2002:909)? Are thereare any limitsto
medicalized, medical cal costs or are all human problems and varia

tions in socially desirable characteristics fodderfor

and treatments? diagnoses of run-away medicalization In sum, the fis may signifi

tions for learning disabled students; yet these

responses cal causes the social classroom class and nonmedi inattention or size or the ter

special

accommoda

cantly impede any effortto reformhealth care Mackie, andMehrotra, 2010). (Conrad,

mination of physical education programs (Conrad 1975).

In each case, and many others, the process by

agitation,

increasing

DIRECTIONS FORTHE FUTURE

We identify several important directionsfor future
social One constructionist intriguing research direction inmedical sociology. for future research is

which human problemsbecome medicalized in the first policy toward ignoredincreating place is largely
these vides issues. A a means social constructionist how of understanding approach pro such problems

come to be defined in medical termsand how this into translates public policy (seeGusfield 1981).As
construc the above attest, medicalized examples tions can also be strongly evaluative (i.e., they sug that authorize social control.

to and that, in comparison experience, privatizing there were almost other forms of social deviance, no illness such subcultures. sites, bulletin of Web an The Internet?with and social interac network tiveWeb sites thousands boards,

to build on recentstudies thatexamine the impact on the illness experience (Barker of the Internet 2008; Conrad and Stults 2010; Pitts 2004). For decades sociologists have shown illness to be a

gest how people ought to behave) and result in

policies For one of the most troubling sociologists, is that it encourages medi results of medicalization social have a context of (Lantz,

as Facebook?is

cal solutionswhile ignoringor downplaying the we Uchtenstein, and Pollack 2007). It seems that
social complicated problems

to just about any illness imaginable, illness is

becoming

that. With changing sites and user groups dedicated public experience.

is leadingnot only to thecreationof illness subcul

to illness-based for medicalization social movements, or demedicaliza and the

increasingly

This

problems as individualor clinical?whether it be

obesity, aging, substance abuse, or alcoholism?rather difficulties, learning the than addressing

predilection

toward

treating human

tures, but also lay demands

tion (Conrad and Stults 2010), new avenues for expanding influence of lay knowledge about of an illness illness.Thirtyyears ago few sufferers or disorder knew otherswith the same ailment; with the Internetthis is becoming increasingly
unlikely, and sharing information and experiences,

causes forcomplex social problemsand underlying We are quick to see individualized human suffering. medical interventions as logically consistent
responses to our troubles 1992). However, medicalization accounts. (see Conrad and Schneider research forces us In so doing, we can be

of clini to recognizeboth theoriginand limitation

cal and medical

for the sociological mill. Sociologists are well

to examine how Internet forums affect

the consequences

of

this are

grist

positioned

This content downloaded from 128.122.149.145 on Sun, 4 Aug 2013 19:52:07 PM All use subject to JSTOR Terms and Conditions

S76

JournalofHealth and Social Behavior 51 (S)

participants'

construction

of illness

identities

and

CONCLUSIONS
we have touchedon severaldifferent In thisarticle ways medical sociologists have utilized a social constructionist approach for studyingillness over the last 50 years.We have highlighted the key findingsof three lines of research and pointed to some policy implicationsof each. First, some ill nesses are particularly embedded with cultural meaning?which is not directlyderived fromthe nature of the condition?that shapes how society and influencestheexpe responds to thoseafflicted rience of that illness. Second, all illnesses are at theexperiential level based socially constructed on how individuals come to understand their ill and livewith and in spite ness, forge theiridentity, of theirillness.Third, as feminist, science studies,
and medicalization medical knowledge have demonstrated, analysts about disease is not necessar

the impacton theirillnessexperience.Beyond just

the role of the Internet, future social construction

will need to track the rising influ ist researchers ence of laypeopleand layknowledge about illness, the institution ofmedicine, and thenatureof health
care. As

lective illness behavior, includinggenerating lay mean medical care,what will be the impacton the the and the role of of delivery services, ing illness, medical profession?Laypeo and influenceof the medical knowledge and,with orwithout the Inter
net, organize ple can use the Internet to promote to create and gather claims have new knowledge, and ever-more active consumers of

laypeople

become

more

involved

in col

their own

about

sources and treatments of illness (Brown 2007).

to 50 years ago, physicians expe

rienced a relativedecline inprofessionalauthority. and reinforcing this trend,laypeo Both reflecting ple with illnesshave a greatervoice, and there is also greater recognitionof thatvoice. The policy implicationsrelated to this shiftare an important
area of future research.

Compared

ily objectively given in nature; rather,it is con structed and developed by claims-makers and interested have a strong parties who frequently
evaluative

Medicalization studieswill continue to be an As the United States moves tionist tradition. toward health care reformand the potential of
universal important area of research in the social construc

date scientific andmedical perspectives,but rather

demonstrate social that diseases and illnesses are as much ones. products as medical-scientific

agenda.

These

findings

do not

invali

how will medicalization impact what is covered, and how will what is covered impact medicaliza
tion? How will the rise of commercialized enhancements medi cine and biomedicai

(or at least expanded)

health

insurance,

These findings,although sociologically signifi cant in theirown right, have a number of policy of Some these have already been implications. but others have way into yet tofind their adopted, gencies of illness at the individual, institutional,
and societal levels, a social constructionist conceptual wedge approach provides an invaluable the policy arena. By revealing the social contin

and drugs) impactourmedical costs, andwhat role will the forces toward medicalization play in this
area? For example, treatments, will health insurance cover interventions for genetic gastric bypass surgeries, and biomedi cai enhancements such as human growth hormone infertility "addictions," for short stature or so-called

(e.g.,

genetics

for policy formulation.It brings our attentionto

contingent some spaces where can fundamentally constructionist form of action alter (or subsequent reminds us that

inaction) events. A

and intellectual workers? medications) for students Of course,unbridled medicalization isjustonemore

reason health care reform is so difficult

smart drugs

(stimulant

but health care reform may, in fact,be one of the few countervailing forces towhat otherwiseseems
to be

to achieve,

how a problem is defined affects how (or even if) to the society responds problem, and how the experiences of individuals are influencedby the
definition social and response constructionism provides to their problem. As such, a counter tomedi

approach

tion. Perhaps the problem of medicalization can

a help us as society to realize that our resources are limited, even if the promises made by the commer cial biomedicai industry are seemingly boundless. In other words, are the processes of medicalization of considerable and

an ever-increasing

trend toward medicaliza

cine's deterministic ways thatcan broaden logic in and enrichpolicy deliberationsand decisions. To
that end, we must

and sociologistsare ina good position to studythose

processes inform the debate.

importance

in the health care debate,

is thedefinitionof the problem upon which this policy is based, how was itdeveloped, and what are theconsequences of adopting thisdefinition?" Without these theoretically important questions to us we in will make guide decision-making, likely
serious health errors in the implementation reforms and health-related policy of future initiatives

routinely

ask ourselves,

"What

This content downloaded from 128.122.149.145 on Sun, 4 Aug 2013 19:52:07 PM All use subject to JSTOR Terms and Conditions

Conrad and Barker

S77

ACKNOWLEDGMENTS
Our thanks to Renee Anspach, Pavalko, also and feedback Paula Lantz, the JHSB for editor Eliza article. We editing. anonymous reviewers their constructive on earlier drafts of this for his careful copy

REFERENCES
Acemoglu, quences Daron and Joshua D. Angrist. 2001. "Conse of the of Employment Protection? The Case Americans with Disabilities Act." Journal ofPolitical 2006. Screen

thank Val Burris

Economy 109:915-57. . K., A. Aalborg, P. Lyons, and L. Keranen. Amy, "Barriers to Routine Gynecological Cancer ing forObese White Armstrong, Elizabeth M. ing Responsibility: Diagnosis Banks, with ofMoral

NOTES
1. Our task in this article is to highlight themost cant findings and policy constructionism. As that signifi implications of social we do not showcase the such, do, however,

and African American Women." 30:147-55. Risk, Bear the The

International Journal of Obesity Fetal Alcohol Disorder.

2003. Conceiving

Syndrome and

Baltimore, MD:

criticisms of social constructionism. We acknowledge Among there are

Johns Hopkins University Press. Jonathan and Lindsay Prior. 2001. "Doing Things Illness: The Micro Politics of the CFS Clinic." Science and Medicine 52:11-23. 1998. "A Ship upon a Stormy Sea: The of Pregnancy." Social Science and

important critiques.

the principal charges: social constructionism explicitly or implicitly denies the existence of the and it trips over or ignores questions some ideas are better representa whether concerning tions of the world than others. Ian Hacking (1999) also alleges that social constructionism inevitably -. reproduces a false binary between things that are real (and therefore have an entirely biophysical basis) and

Social

natural world,

Barker, Kristin. Medicalization Medicine

47:1067-76. Story: Medical Author PA:

2005. The Fibromyalgia ity and Women's Worlds Temple University Press. 2008. "Electronic

of Pain.

Philadelphia,

-. things that are socially constructed (and therefore a no As have result, biophysical basis whatsoever). Hacking contends, social constructionism fails to con that something can be both real sociologists have sider the possibility

Support

Groups,

Patient

Consumers, andMedicalization: Barnes, Colin, Geof Mercer, Exploring Barry, Collean, and Mark How Beliefs Disability: Victoria Maiden, MA:

The Case of Contested

Health and Social Behavior49:20-36. Illness.' 'Journal of and Tom Shakespeare. A Sociological Bresscall, 2009. Kelly 1999. Introduction.

and socially constructed. However,

often supported this both/and view. For example, they suggest that the social forces constructing the defini tion and treatment of illness are themselves real phenomena that can be studied empirically 1970). Moreover, what often rests on social dynamics (Brown and pro is judged to be

Polity Press. D. Brownell,

Schlesinger.

"Obesity Metaphors: 87:7-47. Studies in the Sociol

about Obesity Affect Support for Public Quarterly 1963. Outsiders:

1995; Freidson biological cesses

Policy." The Milbank Becker, Howard.

(Joyce 2008; Timmermans 2007). Following Freidson (1970), we do not think it is sociology's job to adjudicate between what is "really" a disease or ill ness and what is "socially constructed." Indeed, like Hacking we consider this to be a false binary. From a the point is to social constructionist perspective, investigate how something comes to be defined as a or "illness" in the first place. Sociologists can further study the extant and changing cultural "disease" meanings that may inhere in a disease or illness while remaining agnostic about the "underlying" biological condition. In any given case, it is the viability of the idea of disease or illness itself (rather than itsvalidity, -. 2. Even per se) that is of greatest interest to sociologists. the latter,more sociological approach misses themark if being overweight merely represents part -. of the normal variation among humans, and, by itself, doesn't produce poor health.

ogy ofDeviance. New York: Free Press. on the 1990. "Sociological Bell, Susan. Perspectives Annals of theNew of Menopause." Medicalization York Academy of Sciences 592:173-78. 1966. The Social Berger, Peter and Thomas Luckmann. Construction of Reality: A Treatise in the Sociology ofKnowledge. Blumer, Herbert. New York: Anchor. 1969. Symbolic Interactionism: Perspec tive and Method. Englewood Cliffs, NJ: Prentice-Hall. and Toxic Waste of Know Lay and Professional Ways

Brown, Phil. 1992. "Popular Epidemiology Contamination:

ing." Journal ofHealth and Social Behavior 33:267-81. 1995. '"Naming and Framing:' The Social Con struction of Diagnosis and Social Behavior and Illness." Journal ofHealth 36(Extra Health Issue):34-52. Contested Movement. Illnesses New and York:

2007. Toxic Exposures: the Environmental Columbia University Press.

This content downloaded from 128.122.149.145 on Sun, 4 Aug 2013 19:52:07 PM All use subject to JSTOR Terms and Conditions

S78

JournalofHealth and Social Behavior 51 (S)

1975. The Birth Medical of of the Clinic: An

Brown, Phil, Stephen Zavestoski, Brian Mayer,

Sabrina McCormick, and Rebecca -.

Foucault, Michel. Archaeology tage Books.

Rachel Morello-Frosch, to Social Movements and Illness 26:50-80. "Chronic Illness

Perception. and Punish:

New York: Vin

Gesior Altman. 2004. "Embodied Health Movements: New Approaches Sociology Bury, Michael. 167-82. Charmaz, Kathy. 1991. Good Days, Bad Days: The Self in Chronic Illness and Time. New Brunswick, NJ: Rutgers University Press. Clarke, Adele. Sex. Conrad, Notes -. 1998. Disciplining Reproduction: Moder of nity,American Life Sciences, and "The Problems " Berkeley: University of California Press. Peter. 1975. "The Discovery 23:12-21. of Illness: Recent in theSociology and of Hyperkinesis: Behavior." on theMedicalization of Deviant ofHealth 1982. in Health."

1977. Discipline Fox, N. J.,K. J. Ward,

The Birth of the 2005. "The

Prison. New York: Vintage. and A. J. O'Rourke. 4: 'Expert Patient': Empowerment orMedical Internet."Social Science andMedicine ness, and Ethics. Chicago, cago Press. Freidson, Eliot. 1970. Profession ofMedicine: A Study of the Sociology Harper and Row. Glaser, Barney G. and Anselm C. Strauss. 1965. Aware ness ofDying. Chicago, IL: Aldine Transaction. Goffman, Erving. 1961. Asylums: Essays on the Social Situation of Mental Patients and Other Inmates. Gar on den City, NJ: Doubleday. New York: Dominance?

as Biographi and Illness

cal Disruption."

Sociology

of Health

The Case of Weight Loss, Pharmaceutical Drugs and the 60:1299-1309. Frank, Arthur. 1995. The Wounded Storyteller: Body, Ill IL: The University of Chi

of Applied Knowledge.

Social Problems

1987. "The Experience New Directions." Care 6:1-31. Research

Health of On the -.

-.

2007. Disorders.

The Medicalization ofHuman Baltimore, MD:

of Society:

1963. Stigma: Notes Spoiled Gusfield, Identity. Englewood

theManagement

of

Transformation versity Press.

Conditions

into Treatable Uni

Cliffs, NJ: Prentice-Hall.

The Johns Hopkins and Ateev Mehrotra. Social

J.R. 1967. "Moral Passage: The Symbolic Pro cess in the Public Designations of Deviance." Social 15:175-88. of Ownership Abuse Issues and Responsi and Automo 1975. "Categories

Conrad, Peter, Thomas Mackie,

2010. Sci -.

Problems

"Estimating the Costs ofMedicalization." ence and Medicine 70:1943^17. Conrad, Peter and Joseph W. and Medicalization: Schneider.

bility in Social Phil -.

Issues: Alcohol

1992. Deviance to Sickness.

bile Use." Journal ofDrug

5:285-303. Chicago,

From Badness

1981. The Culture of Public Problems.

adelphia, PA: Temple University Press. Conrad, Peter and Cheryl Stults. 2010. "Internet and the Illness Experience." Medical Sociology. Edward. University Press. Dolnick, Dumit, 1993. "Deafness as Culture." The Atlantic 272(3):37-53. Joseph. 2006. Facts and Forces Science Barbara "Illness You Have inUncertain, and Deirdre to Fight to Get: Illnesses." 1978. For to Emergent English. Pp. 179-91 in The Handbook 6th ed. Nashville, of TN: Vanderbilt

IL: The University of Chicago Press. Gussow, Zachary and George S. Tracy. 1968. "Status, Ideology and Adaptation to Stigmatized Illness: The Case Hacking, of Leprosy. "Human Ian. Organization 27:316-25. 1999. The Social Construction of What?

Cambridge, MA: Harvard University Press. 1999. "Doctor in the House: The Internetas Hardey, Michael. a Source of Lay Health Knowledge and theChallenge to Health Expertise." Sociology of Hartley, Heather. 2006. "The Drug Drugs for Women." and Illness 21:820-35. and Repackage 9:363-78. 2007. The Loss Sex 'Pinking' ofViagra Culture:

Social

and Medicine

62:577-90.

Ehrenreich,

Industry Efforts to Create Sexualities

Her Own Good:

150 Years of theExperts'Advice

Women. Garden City, NY: Doubleday. Eisenberg, Leon. 1977. "Disease and Illness: Distinctions between Professional Culture, Medicine Epstein, Steven. and thePolitics -. 2007. Medical Chicago and Popular Ideas of Sickness." 1:9-23. AIDS, Activism, and Psychiatry ofKnowledge.

Horwitz, Allan of Sadness: Sorrow

and Jerome C. Wakefield. How

Psychiatry Transformed Normal intoDepressive Disorder. New York: Oxford 2008. Magnetic Appeal: MPI and the Myth

University Press. Joyce, Kelly. Ithaca, NY: Cornell University Press. 2008. The Biopolitics of Breast Cancer.

1996. Impure Science:

Berkeley: University of Difference in of

of Transparency. Klawiter, Maren.

of California Press. Inclusion: The Politics Research. Press. IL: The University

Chicago,

Minneapolis: University ofMinnesota Press. Kleinman, Arthur. 1988. The Illness Narratives: Suffering, Human Condition. New York: Basic Books. Healing and the

This content downloaded from 128.122.149.145 on Sun, 4 Aug 2013 19:52:07 PM All use subject to JSTOR Terms and Conditions

Conrad and Barker

S79

Klitzman, MD:

Robert

and Ronald

Secrets: Truth and Lies

Beyer. 2003. Mortal in theAge ofAIDS. Baltimore, 1997. Bodies in

Rose, Nikolas. Power

2006. Politics

and Subjectivity

of Life Itself: Biomedicine, in the Twenty-First Century.

Johns Hopkins University Press. Steve and Huge H. Floyd. Illness and the Struggle over and Harold A. to Popu Health

Kroll-Smith,

Princeton, NJ: Princeton University Press. 1989. Epilepsy. London, Scambler, Graham. Taylor and Francis. Schneider, Epilepsy: Joseph W. and Peter Conrad.

England:

Protest: Environmental

Medical Knowledge. New York: New York University Press. Lantz, Paula M., Richard L. Uchtenstein, Pollack. 2007. lation Health: "Health Policy Approaches The Limits ofMedicalization." "A Decade

1983. Having of Illness.

The Experience

and Control

Philadelphia, Schutz, Alfred. Sciences."

PA: Temple University Press. 1967. "Phenomenology 118-39 in Collected and the Social Papers, Vol. 1,

Affairs 26:1253-51. Lee, Barbara. Disabilities Problems." 2001. Act: of the Americans 42:11-30. with Judicial Outcomes and Unresolved

Pp.

The Problem of Social Reality, edited byM. Natanson. The Hague, The Netherlands: M. Nijhoff. Snadden, David and Julia Belle Social Brown. Science 1992. "The Experience 12:1352-61. Susan. ofAsthma." and Medicine

Industrial Relations

Man. New York: Appleton Linton, Ralph. 1936. The Study of Century-Crofts. Loe, Meika. 2004. The Rise Sex Blue Pill Changed of Viagra: How The Little inAmerica. New York: New

Sontag,

1978. Illness

as Metaphor.

New

York:

Farrar, Straus and Giroux. Spector, Malcolm Strauss, Anselm Chronic MO: and John Kitsuse. C. 1977. Constructing eds. 1975. Social Problems. Menlo Park, CA: Cummings. of Life. St. Louis,

York University Press. Lorber, Judith. 1997. Gender and theSocial Construction of Illness. Thousand Oaks, CA: Lupton, Deborah. tion Critique." Medicine, 1997. "Foucault Pp. 94-110 Sage. and theM?dicalisa Health and and R. Bunton. New of

and Barney G. Glaser, and the Quality

Illness

inFoucault,

C. V. Mosby. Stephan. 2007. Postmortem: How Medical Chicago, IL:

edited by A. Petersen "The

Timmermans, Examiners

York: Routledge. Susan. 1996. Markens, ence': A Political Gender & Society Mintzes, Medical B. 2002.

Problematic Critique

'Experi

Explain Suspicious Deaths. The University of Chicago Press.

and Cultural 10:42-58.

of PMS."

Timmermans, is

"Direct

to Consumer Human

Advertising

Stephan and Steven Haas. 2008. "Towards a Sociology of Disease." Sociology ofHealth and Ill ness 30:659-76. Power and Social Knowl Sage. Medical of Encoun with Social Prob

Medicalising Oliver, Mike.

Normal

Experience."

British

Turner, Bryan S. 1995.Medical Waitzkin, Howard.

Journal324: 1996.

908-909. "Defining Impairment and Dis the

edge. 2nd ed. Thousand Oaks, CA: 1991. The Politics inExploring ters:How Patients and Doctors Deal

ability: Issues at Stake." Pp. 29-54 Divide, edited by Colin Barnes England: The Disability Press. Peyrot, Mark, James F. McMurry, Experience 1987. "Living with Diabetes." and Management

and G. Mercer. Leeds, and Richard Hedges. Pp. 107-46 in The

lems. New Haven, CT: Yale University Press. Weitz, Rose. Qualitative Williams, 1990. "Living with the Stigma of AIDS." Sociology 13:23-38.

edited by J.A. Roth JAI Press. Pitts, Victoria. 2004. ment: Writing space." Health: the Social 8:33-59.

of Chronic Illness, and P. Conrad. Greenwich, CT: and Internet Empower -.

Simon. 2005. Sleep and Society: Sociological Ventures into the (Un)known. New York: Routledge. 1972. "Medicine as an Institution Zola, Irving Kenneth. of Social Control." Sociological Review 20:487-504. 1982.Missing Pieces: A Chronicle of Living with a Disability. Philadelphia, PA: Temple University Press.

"Illness

and Reading Breast Cancer in Cyber An Interdisciplinary Journal for Illness, and Medicine

Study of Health,

Bios
Peter Conrad is Harry Copian Professor of Social Sci ences at Brandeis University. His most recent book is The of Society: On the Transformation (Johns Hop of Conditions into Treatable Disorders

Popay, Jennie and Gareth Williams. Research Medicine Radin, and Lay Knowledge." 42:759-68. 2006. '"To Me,

1996. "Public Health Social Science and

Medicalization It's My Life': Medical inCyberspace." Human

Patricia.

Communication, Social Riessman, A New Riska, Science Catherine.

Trust, and Activism and Medicine

kins University Press, 2007). Kristin K. Barker is associate professor of sociology at State Oregon University. She is the author of The Fibro myalgia Story: Medical Authority and Women s Worlds of (Temple University Press, 2005).

62:591-601. 14:3-18.

1983. "Women and Medicalization: Social Policy the Medicalization "Gendering in Gender Research 7:61-89.

Perspective." 2003.

Elianne.

Thesis." Advances

Pain

This content downloaded from 128.122.149.145 on Sun, 4 Aug 2013 19:52:07 PM All use subject to JSTOR Terms and Conditions