is his analysis of the social functions of the medical profession, including the use of medical knowledge as a means of social control and regulation, as he studied madness, clinics, and sexuality. Foucault (1973) found two distinct trends emerging in the history of medical practice: “medicine of the species” (the classification, diagnosis, and treatment of disease) and “medicine of social spaces” (the prevention of disease). The former defined the human body as an object of study subject to medical intervention and control, while the latter made the public’s health subject to medical and civil regulation. The surveillance of human sexuality by the state, church, and medicine subjected the most intimate bodily activities to institutional discourse and monitoring. Thus, bodies themselves came under the jurisdiction of experts on behalf of society.
Foucault’s approach to the study of the body also influenced the development of a new specialty, the sociology of the body, with Bryan Turner’s book The Body and Society (2008, originally published in 1984) the seminal work in this area. Theoretical developments concerning the sociological understanding of the control, use, and the phenomenological experience of the body, including emotions, have been most pronounced in Britain. One area of inquiry is directed toward understanding the dialectical relationship between the physical body and human subjectivity or the “lived” or phenomenological experience of both having and being in a body.
Foucault has his critics. Some suggest that Foucault’s perspective on knowledge/power does not take limits on power into account, nor explain relations between macro-level power structures other than dwell on their mechanisms for reproduction; moreover, there is a disregard of agency in poststructural concepts. Giddens (1987: 98), for example, noted that Foucault’s history tends to have no active subjects at all and concludes: “It is history with the agency removed.” And he (Giddens 1987: 98) goes on to say that the “individuals who appear in Foucault’s analyses seem impotent to determine their own destinies.” Yet Foucault’s knowledge/power equation, applied to the medical profession, remains a useful analysis of their role as “experts” in the social control of the body.
Social Constructionism
Social constructionism is based on the premise that social phenomena are not discovered but constructed through social interaction (Conrad and Barker 2010; Nowakowski and Sumerau 2019; Olafsdottir 2013; Turner 2004). That is, things are what they are defined as, even illness. In medical sociology, this perspective takes “the view that scientific knowledge and biological discourses about the body, health and illness are produced through subjective, historically determined human interests, and are subject to change and reinterpretation” (Gabe et al. 2004: 130). Illness is considered to be socially constructed in that the expression of symptoms is shaped by cultural and moral values, experienced through interaction with other people, and influenced by particular beliefs about what constitutes health and illness. The result is a transformation of physiological symptoms into a diagnosis which produces socially appropriate illness behavior and a modified social status, that of being sick. In medical sociology, one branch of the social constructionist approach is closely tied to Foucault and analyzes the body as a product of power and knowledge as previously discussed (Annandale 2014; Nettleton 2020). The other branch of social constructionism is based on the seminal work of Peter Berger and Thomas Luckmann in their book The Social Construction of Reality (1967), which is grounded in symbolic interaction and its emphasis on agency. This approach is also influenced by Eliot Freidson’s (1970a, 1970b) analysis of medical professionalization. Freidson examined how the medical profession monopolized power and authority in health matters to advance its own interests. Given the significant differences between Berger and Luckmann in comparison to Foucault, it is obvious that social constructionism lacks a single, unified doctrine. According to Turner (2004: 43), “These different types of constructionism present very different accounts of human agency and thus have different implications for an understanding of the relationship between patients, doctors, and disease entities.” The more social constructionist work is influenced by Berger and Luckmann, the more agency oriented it is; the closer to Foucault, the less agency has a role.
Medicalization/Biomedicalization
Medicalization is a major theoretical concept in medical sociology. According to Peter Conrad (2007; 2013), medicalization in its simplest form means “to make medical.” It refers to the process by which previously nonmedical conditions become defined and treated as a medical problem, that is, as either a disease or disorder of some type. Conrad provides several examples of conditions which medicine assumed control over by defining them as a medical problem to be treated by medical means, even though in the past they were not necessarily considered as such. These include attention deficit hyperactivity disorder (ADHD), normal sadness, grief, shyness, premenstrual syndrome (PMS), sleep disorders, aging, obesity, infertility, learning disabilities, erectile dysfunction, surgical cosmetic enhancements, and baldness among others. The approach of the medicalization concept, however, is not to contest diagnoses but examine how a problem becomes defined as medical and the social consequences of doing so.
Conrad finds the sources or “drivers” of medicalization are now changing. Physicians are slowly being sidelined by new engines of medicalization making things medical, namely (1) biotechnology, especially the pharmaceutical industry and genetics, (2) consumers desiring treatments, and (3) managed care when health insurance companies make decisions about what is or is not included in their coverage. The changes connected to the increasing significance of biotechnology have led to the introduction of biomedicalization theory (Clarke et al. 2010). Biomedicalization consists of the rise of computer information and other new technologies to increase medical surveillance and treatment interventions by the use of genetics, bioengineering, chemoprevention, individualized designer drugs, multiple sources of information, patient data banks, digitized patient records, and other innovations. Also important in this process is the Internet making it easier to get medical information and merchandise, be exposed to advertising, and enhance the role of pharmaceutical companies in marketing their products.
Feminist Theory
Feminist theory in medical sociology has been linked in some instance to social constructionist accounts of the female body and its regulation by a male-dominated society. Social and cultural assumptions are held to influence our perceptions of the body, including the use of the male body as the former standard for medical training, the assignment of less socially desirable physical and emotional traits to women, and the ways in which women’s illnesses are socially constructed (Annandale 2014). Other feminist theory is grounded in conflict theory or symbolic interaction, and deals with the sexist treatment of women patients by male doctors and the less than equal status of female physicians in professional settings and hierarchies (Riska and Wegar 1993; Hinze 2004). There is, however, no unified perspective among feminist theorists other than a “woman-centered” perspective that examines the various facets of women’s health and seeks an end to sexist orientations in health and illness and society at large (Annandale 2014; Nettleton 2020).
Intersectionality theory, originating among American black feminist scholars has been one of the more promising feminist theoretical perspectives expanding into medical sociology (Collins 2015, 2019; Collins and Bilge 2016). It calls attention to the multiple forms of social inequality affecting black women and other disadvantaged individuals. In doing so, it expresses an activist orientation connected to community organizing, identity politics, coalition politics, and social justice. The approach focuses on examining forms of discrimination and inequality stemming from gender, race, ethnicity, class, age, nation, and sexual orientation, and makes the key point that such variables are not simply individual characteristics but operate simultaneously at multiple levels in people’s lives. Thus, individual and group characteristics cannot be fully understood by prioritizing one variable (e.g. class) over another (e.g. gender) since all such variables combine to disadvantage some people in relation to others at the same time. People do not experience inequality only from the standpoint of one social characteristic but undergo all of them concurrently. Intersectionality theory therefore provides a perspective
