Thesis advisor: Sharlene N. Hesse-Biber / Birth Visionaries: An Examination of Unassisted Childbirth By Lauren Ashley Brown Sharlene Nagy Hesse-Biber, Thesis Chair This exploratory study inquires into unassisted childbirth, the act of giving birth without the presence of any birth professional (doctor, midwife or doula). Unassisted birth is on the radical fringe of alternatives to the dominant techno-medical birth common in American hospitals today. My research questions are what are women's motivations for choosing unassisted childbirth and what is the lived experience of unassisted childbirth? I will answer these questions through nine in-depth interviews and a grounded theory data analysis. My approach comes from a focus on the everyday lived experience of women as problematic as well as insights from anthropology of birth and feminist postmodern sociology of knowledge. This study is relevant to public health policy on pregnancy and birth, to those working on questions of technology and culture, and to those concerned with how biosocial rituals shape embodied experience. My findings also contribute to research about power in contemporary society, specifically how the body can be a cite for social control and resistance. / Thesis (MA) — Boston College, 2009. / Submitted to: Boston College. Graduate School of Arts and Sciences. / Discipline: Sociology.

ABSTRACT “DEPRESSION IS A MEDICAL CONDITION”: EXPLORING THE MEDICALIZATION OF DEPRESSION ON SSRI WEBSITES Sociologists of medicine have become increasingly interested in mental health over the last two decades (Pilgrim and Rogers, 2005). Known as the “common cold” of mental illness, depression affects millions around the globe. The social understanding of depression has been shaped by a phenomenon known as medicalization, where an unusual behavior or state of being is labeled illness or disorder or disease, and addressed through rationalized medical intervention. The medicalization of depression is particularly evident on SSRI websites. SSRIs (Selective Serotonin Reuptake Inhibitors) are a popular class of antidepressants used to treat depression. Pharmaceutical companies who manufacture these medications now advertise their products on the Internet, an increasingly popular source for health information. This thesis is a critical, empirical investigation of the medicalization of depression on SSRI websites. Five major research questions guide this study. First, how is depression portrayed on the websites? Second, what are the means used to construct this portrayal? Third, who is the apparent target audience? Fourth, what assumptions are made about this audience? Finally, what is absent from or silent in the websites? These questions are answered using an analytical framework called Critical Discourse Analysis (CDA). This framework is both a theoretical orientation and a methodological process (Fairclough, 1992). This study reveals that medicalization has a strong impact on the portrayal of depression on the websites, and is the major perspective from which the issue is approached. The depressed person is seen to be affected by depression in a variety of ways, including being ill with a medical condition and at risk for further difficulty if treatment is not handled properly. A variety of means are used to construct the portrayal of depression, including structural means such as interactional controls, linguistic means such as word choices and meanings, and visual means such as the use of diagrams and caricatures. Embedded in the text are a number of indicators which highlight some apparent assumptions about the targeted audience, such as insurance coverage and general literacy. Absences or silences in the texts include a failure to discuss the prevention of depression. The most significant finding concerns “the symptom/side-effect” problem; this dilemma highlights the lack of clarity around definitions of recovery and mental health as well as the purpose of taking medications. It also reveals that, while the application of the medicalized perspective to depression is certainly useful given the efficacy of antidepressant drugs for many people, it is not infallible and requires careful critical consideration.

ABSTRACT “DEPRESSION IS A MEDICAL CONDITION”: EXPLORING THE MEDICALIZATION OF DEPRESSION ON SSRI WEBSITES Sociologists of medicine have become increasingly interested in mental health over the last two decades (Pilgrim and Rogers, 2005). Known as the “common cold” of mental illness, depression affects millions around the globe. The social understanding of depression has been shaped by a phenomenon known as medicalization, where an unusual behavior or state of being is labeled illness or disorder or disease, and addressed through rationalized medical intervention. The medicalization of depression is particularly evident on SSRI websites. SSRIs (Selective Serotonin Reuptake Inhibitors) are a popular class of antidepressants used to treat depression. Pharmaceutical companies who manufacture these medications now advertise their products on the Internet, an increasingly popular source for health information. This thesis is a critical, empirical investigation of the medicalization of depression on SSRI websites. Five major research questions guide this study. First, how is depression portrayed on the websites? Second, what are the means used to construct this portrayal? Third, who is the apparent target audience? Fourth, what assumptions are made about this audience? Finally, what is absent from or silent in the websites? These questions are answered using an analytical framework called Critical Discourse Analysis (CDA). This framework is both a theoretical orientation and a methodological process (Fairclough, 1992). This study reveals that medicalization has a strong impact on the portrayal of depression on the websites, and is the major perspective from which the issue is approached. The depressed person is seen to be affected by depression in a variety of ways, including being ill with a medical condition and at risk for further difficulty if treatment is not handled properly. A variety of means are used to construct the portrayal of depression, including structural means such as interactional controls, linguistic means such as word choices and meanings, and visual means such as the use of diagrams and caricatures. Embedded in the text are a number of indicators which highlight some apparent assumptions about the targeted audience, such as insurance coverage and general literacy. Absences or silences in the texts include a failure to discuss the prevention of depression. The most significant finding concerns “the symptom/side-effect” problem; this dilemma highlights the lack of clarity around definitions of recovery and mental health as well as the purpose of taking medications. It also reveals that, while the application of the medicalized perspective to depression is certainly useful given the efficacy of antidepressant drugs for many people, it is not infallible and requires careful critical consideration.

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In June 2015, Caitlyn Jenner created waves of excitement with her coming out announcement on the cover of Vanity Fair: “Call me Caitlyn.” From the perspective of critical trans politics, however, the heightened visibility of trans people in mainstream media does not call for unequivocal celebration. Though trans women of color, such as Laverne Cox and Janet Mock, are more visible in mainstream media than ever before, mainstream media still largely depicts trans people through white constructs of what it means to be trans, namely medicalized binary transitions. Many trans people who deviate from mainstream media’s depiction of trans people are creating their own media on YouTube to voice their lived experiences. I argue that while YouTube is a particularly accessible platform for trans people to challenge transnormativity, the reach of trans YouTubers’ messages are highly limited by the medium’s design and genre conventions.

Medicalization as a Trojan Horse: Changes in Erectile Enhancement Advertising By Robert D Wood, M.S. A Thesis submitted in partial fulfillment of the requirements for the degree of Master of Science at Virginia Commonwealth University Virginia Commonwealth University, 2011 Major Director: Sarah Jane Brubaker, PhD, Graduate Program of Sociology This thesis investigates the medicalization of “inadequate penis size” through an analysis of online advertising of “male enhancement,” or erectile enhancement (EE) products. The process of medicalization, as defined by Peter Conrad, is the process by which non-medical problems become defined and treated as such (2007). With the advent and success of Viagra (Sildenafil) in 1998, a wave of products emerged treating erectile dysfunction and not long after followed the expansion of the market for erectile enhancement. Although several studies have been done of erectile dysfunction, there has been less research on the advertisement techniques within the erectile enhancement market. Brubaker and Johnson's article “'Pack a more powerful punch' and 'lay the pipe': erectile enhancement discourse as a body project for masculinity” dissects such advertising for overarching themes of violence, the subjugation of women, and the perpetuation of hegemonic masculinity (2008). This analysis was done in 2006, and evidence presented in this thesis suggests that the advertising techniques, particularly as they appear in erectile enhancement websites, show some dramatic differences in presentation and themes. These more recent advertisements seem to reflect a more medical approach, emphasizing an authoritative medical appearance, downplaying violent, misogynistic, or sexist undertones consistent with much of erectile enhancement advertising. This new medical approach is a metaphorical Trojan horse, sneaking in and maintaining older concepts of domination and violence. The background of hegemonic masculinity in erectile enhancement advertising is continued under the guise of medical professionalism. Through quantitative and qualitative analysis of ten erectile enhancement product websites, I show how the advertising involved in this industry has attempted to medicalize the small penis in hopes of marketing an “inadequate penis” as a more legitimate, medical concern. This study thus contributes to a better understanding of the changing social concepts of manhood, how the process of medicalization works, and how it can be seen within the area of erectile enhancement.

<p>Problem gambling, a fairly recent addition to the Diagnostic and Statistical Manual of Mental Disorders, is estimated to affect between two and five percent of the US adult population (Volberg 2001). While present in all racial groups, this disorder is not evenly distributed, as Blacks are more likely than any other group to become problem gamblers (Welte et al. 2006). And while this pattern is consistent with those found with other disorders (Black 1984; Ford and Widiger 1989; Strakowski et al. 1993), it is important to note that thirty years ago, when the first study of problem gambling prevalence was conducted and the disease had only recently been institutionalized, there was no difference in rate of illness by race (Kallick et al. 1979). This dissertation aims to explore this phenomenon: the role of race in the making of problem of gambling. </p><p>Through a multi-site and multi-method approach, this study examines the assumed race neutrality of gambling addiction. By tracing the history of gambling policy and North Carolina's adoption of a lottery program, this study explores how the state further defined problem gambling as a mental illness. Following this, participant observation of state-sponsored problem gambling counselor training workshops provides insight into the ways racialized understandings of behavior are constructed and maintained through counselor education. To gain a sense of how gambling is lived, this study involves participant observation of lottery gambling in convenience stores to interrogate racialized conceptions of behavior and reveal how financial gain motivates gambling across groups.</p> / Dissertation

O fenômeno da medicalização organiza, hoje, o modo como as pessoas vivem e se compreendem. Desde os anos 1960, esse tema ganhou destaque em diversos artigos. Entendese que tal processo é complexo e, além de produzir a patologização da vida, também pode ser analisado como uma resposta a diversas necessidades humanas. Na presente pesquisa, o processo de medicalização foi pensado a partir do referencial teórico-metodológico da fenomenologia, compreendendo o homem como ser-no-mundo, cuja humanidade reside na sua essência de ser desvelador de mundo. Nessa perspectiva, a medicalização expressa um modo de compreensão técnico do mundo, um processo que busca controlar, assegurar, padronizar e prever os fenômenos multideterminados do ser humano, submetendo a complexidade deste à disciplina da medicina, que sempre poderá lhe oferecer intervenções e explicações. A resistência a esse processo torna-se um tema importante de pesquisa, dada sua abrangência e profundidade no modo de vida atual. A psiquiatria francesa apresenta resistências singulares ao hiperdiagnóstico do TDAH, uma expressão da medicalização. O trabalho de campo foi realizado na França e buscou formular articulações com o enfrentamento brasileiro. O objetivo geral desta pesquisa é investigar o sentido da resistência à medicalização, de modo a ampliar a compreensão desse fenômeno. Para tanto, dois aportes de dados foram utilizados: a análise documental dos coletivos Pas de Zéro de Conduite pour les enfants de trois ans, Lappel des appels e Stop-DSM e a análise de entrevistas com profissionais da saúde franceses. Para a análise das entrevistas, baseamo-nos na Hermenêutica da Facticidade. As entrevistas foram realizadas em formato de rede: a cada conversa a pesquisadora apresentava elementos que surgiram nas entrevistas anteriores, de modo que a própria pesquisa se tornasse um instrumento de resistência, coletivizando a discussão do tema. Assim, após a etapa de campo na França, entrevistamos Manuel Vallée, da Universidade de Auckland, cujo artigo foi citado em todas as conversas com os profissionais franceses. Como resultado, partindo das estratégias apreendidas em campo, chegamos a quatro fundamentos da resistência à medicalização na França: 1) a concepção de homem como possibilidade de ser, entendendo que ele está sempre aberto para as possibilidades que se apresentam no futuro indeterminado, resistindo à cristalização de um diagnóstico; 2) a pluralidade de práticas e métodos de pesquisa coexistindo de forma a contrapor o monismo metodológico; 3) a construção de redes como estratégia de enfrentamento à individualização/biologização das problemáticas humanas; 4) as intervenções multifocais, com cuidado multidisciplinar, considerando o contexto social, cultural e político dos usuários como enfrentamento à hiperprescrição de medicamentos pautada por interesses financeiros na área da saúde. No processo de medicalização da sociedade, o lugar de convivência entre os homens, a política, perde seu espaço para a ciência, que passa a regulamentar o modo como os homens devem viver, assegurando os resultados dos seus modos de vida. As estratégias de resistência à medicalização apreendidas nesta pesquisa apontam para o fortalecimento do campo político, âmbito em que a verdade plural vigora, como principal direcionamento desse enfrentamento / The phenomenon of medicalization organizes today how people lives and understands themselves. Since the 1960s, this subject has gained prominence in several articles. It is understood that such a process is complex and, in addition to producing the pathologization of life, it can also be analyzed as a response to various human needs. The process of medicalization was thought from the theoretical-methodological referential of the phenomenology, comprising man as a being-in-the-world, whose humanity resides in his essence of being someone who uncovers the world. In this perspective, medicalization expresses a way of technically understanding the world, a process that seeks to control, ensure, standardize, and predict the multi-determinate phenomena of the human being, subjecting its complexity to the discipline of medicine, which can always offer it interventions and explanations. The resistance to this process becomes an important research topic given its scope and depth in the current way of life. French psychiatry has unique resistances to the hyperdiagnosis of ADHD, which is an expression of medicalization. The fieldwork was carried out in France and it seeks to articulate with the Brazilian confrontation. The overall objective of this research is to investigate the meaning of resistance to medicalization, in order to broaden the understanding of this phenomenon. To that end, two data sources were used: the documentary analysis of the collectives Pas de Zéro de Conduite pour les enfants de trois ans, L\'appel des appels and Stop-DSM and the interviews with French healthcare professionals. For the analysis of the interviews, we were based on the Hermeneutics of the Facticity. The interviews were carried out in a network format: at each conversation, the investigator presented elements that were brought up in the previous interviews, so that the research itself became an instrument of opposition, collectivizing the discussion of the subject. Thus, after the field stage in France, we interviewed Manuel Vallée of the University of Auckland, whose article was quoted in all conversations with the French. As a result, we came to four elements of the resistance to medicalization in France: 1) the conception of man as a possibility of being, understanding that he is always open to the possibilities that present themselves in the indeterminate future, resisting to the crystallization of a diagnosis; 2) the plurality of practices and research methods coexisting so as to counter methodological monism; 3) the construction of networks as a strategy to confront the individualization / biologization of human problems; 4) multifocal interventions, with multidisciplinary care considering the social, cultural, and political context of the users as a confrontation with the hyperprescription of medicines guided by financial interests in the healthcare area. In the process of medicalization of society, the place of coexistence between men, the politics, loses its space for science, which governs how men should live, ensuring the results of their ways of life. The elements of the resistance to medicalization observed, point to the strengthening of the political field, in which plural truth prevails, as the main direction of this confrontation