Attention Deficit/Hyperactivity Disorder has garnered controversy in the United States since it became a widely diagnosed disorder in American schoolchildren in the 1970s. Both diagnosis and treatment are sites of controversy. Some believe the disorder is a contrivance of parents and teachers who do not want to deal with hardly exceptional childhood difficulties, or a contrivance of pharmaceutical companies taking advantage of such parents and teachers. Others believe that a neurobiological basis for the disorder will eventually be discovered, and thus will legitimize both the diagnosis and the practice of prescribing medication for treatment. I utilize the Science, Technology, and Society approach of actor network theory to show that these multiple understandings of ADHD can coexist, since ADHD is a complex product of external and internal agents. This will demonstrate how cultural shifts and values cause parents, teachers, and doctors to evaluate childhood in a way that frames certain behaviors as harmful. I also evaluate how cultural values of medicalization center issues in the individual rather than in external factors, and assess the values that psychiatric treatment appeals to and whether they primarily serve the needs of children. I conclude that ADHD is a heavily context-dependent disorder, but that that does not delegitimize harmful effect on children who exhibit ADHD-associated behaviors. I also conclude that the current dominant medicalized approach to ADHD is not optimal because it focuses on only a few of the total factors that make ADHD a pathological disorder for children in the contemporary United States.

Within this thesis I examine Western practices and conceptualizations of childbirth from three distinct angles, with the goal of better understanding how one can negotiate agency in contemporary childbirth. First, I outline the history of the medicalization of childbirth in the West, using a reference frame of the famous second wave feminist text, Our Bodies, Ourselves. Next, I conceptualize agency in the context of contemporary childbirth, first defining the ‘agency’ that I am working with, and then outlining some of the factors that play into the negotiation of agency in one’s childbirth; some of these factors include race, class, location, and information provided about specific medical and physical procedures. Finally, I destabilize the hegemonic Western understanding of labor and birth pain by situating pain as culturally constructed and contextually specific. I provide a few examples of ways in which we can reconceptualize pain in a way that situates it as a unique experience for each individual. The end goal of this thesis is to contextualize current childbirth practices within a specific history of medicalization, and to illustrate the complex nature of agency, but the importance of it to a childbirth in which the mother feels as safe and supported as possible.

This paper presents a critical analysis of the cultural and social constructions of aging and the aged which pervade public discourse around the growing population of elders in the U.S. Elders are socially 'othered' through processes of medicalization and categorization as an "at risk" group. Furthermore, elders are culturally constructed as unproductive and overconsumptive collective resources. As elders become increasingly central in social and political discourse surrounding health care and the division of resources, these culturally and socially constructed stereotypes have a real impact on social identity and policy decisions. The paper concludes with a discussion of the role of anthropology in contributing a critical perspective to the study of elders.

The question this dissertation seeks to address is if the process of disease mongering can be ethically assessed. Chapter one provides a broad scope of the ethical challenge of disease mongering, UNESCO model framework, ADHD and PMDD. Chapter two examines disease mongering and its driving forces in detail. Chapter three provides an overview of the UNESCO model framework. Chapter four ethically examines disease mongering in conjunction with Attention Deficit Hyperactivity Disorder (ADHD). Chapter five examines disease mongering in association with Premenstrual Dysphoric Disorder (PMDD). Chapter six concludes that examined through the UNESCO model ethical framework disease mongering is occurring for both ADHD and PMDD, and provides remarks for the addressing this in the future. / McAnulty College and Graduate School of Liberal Arts; / Health Care Ethics / PhD; / Dissertation;

Research confirms that breastfeeding disparities persist and that lactation consultants play a key role in reducing them. However, there continues to be a limited availability of International Board Certified Lactation Consultants (IBCLCs) in the US with racial minorities in particular facing persistent barriers in the certification process. Through semi-structured interviews with 36 IBCLCs across the US, this study takes a systematic look at breastfeeding disparities through the lens of the IBCLC. Specifically, this study addresses barriers to certification and employment discrimination faced by IBCLCs of color, race-based discrimination against patients, and the ways in which IBCLCs work to both medicalize and demedicalize breastfeeding. Each of these areas can impact breastfeeding equity, and each help to reveal the ways in which race, class, gender and medicine shape views and practices related to lactation and motherhood. Cost and the increasingly university-focused approach of the IBCLC certification process are found to be significant barrier for participants. Race-based discrimination during the certification process and in the workplace is also an ongoing and persistent reality that affects participant’s relationships with patients and coworkers and their ability to secure workplace resources and to advance in their careers. IBCLCs report instances of race-based discrimination against patients such as unequal care provided to patients of color and overt racist remarks said in front of or behind patient’s backs. Finally IBCLCs are found to demedicalize breastfeeding, but they often lack the authority to change breastfeeding policies. They also engage in other work that medicalizes breastfeeding and perpetuate the idea that mothers are anxiety-prone patients in need of professional intervention.

Dans les années 1780, une nouvelle politique française d’encadrement de la naissance choisit lasage-femme comme intermédiaire privilégié entre les attentes médico-administratives et lapopulation. Officialisé par la loi du 19 ventôse an XI sur l’exercice de la médecine, le métier desage-femme n’a plus dès lors qu’un point d’entrée possible et admis : la formation obstétricale.La thèse étudie le consentement des sages-femmes à leur mise en formation, sa chronologie et sesmodalités. Elle aborde la question de la part dans l’évolution de la profession et son renforcementau fil du siècle des dynamiques externes (État, administration, corps médical) et internes (sagesfemmeselles-mêmes). Ou comment les auxiliaires sans instruction de la naissance à la fin duXVIIIe siècle se muent en une profession médicale unifiée au début du XXe siècle.Au-delà, ce travail montre comment l’organisation administrative de la formation, les politiquesde recrutement et la forme des cours participent à la construction d’un nouvel agent sanitaire : lasage-femme qui se retrouve à assumer tour à tour les fonctions d’accoucheuse, de vaccinatrice, demédecin des pauvres ou encore de puéricultrice.En un siècle, les deux-tiers des départements français ont fondé un cours ou une écoled’accouchement. En un siècle, ce sont près de 45 000 sages-femmes qui ont été formées etdiplômées. Cette étude est celle de la construction d’une identité et d’une conscienceprofessionnelle permise par la formation obstétricale. / In the 1780s, the new French policy surrounding childbirth elected the midwife as theintermediary between the medical and administrative powers and the population. From themoment it was made official by the Law of Ventose 19, year XI on the practice of medicine, thesole gateway to midwifery has been obstetrical training.The thesis examines how midwives consented to this training, as well as the timeline of thisconsent and its modalities. It also examines how forces from without (government,administrative rules, physicians) as well as from within (the midwives themselves) created thedynamics allowing the profession to evolve and gain official status in the nineteenth-century—how from untrained birth assistants in the late eighteenth century, midwives turned into a unifiedmedical profession in the early twentieth century.Beyond, this study investigates how administrative guidelines, recruitment policies, trainingcontents and methods led to the creation of a new health worker: the midwife, in charge, byturns, of delivering babies, of performing smallpox vaccinations, of being a doctor to the poor,and of providing expert childcare.In the course of a single century, two-thirds of all French departments founded a midwiferytraining school. Over that century, nearly 45 000 midwives were trained and certified. This studydeals with the construction of a professional identity and a professional conscience, as a result ofobstetrical training.

Esta pesquisa tem por objetivo estudar o processo de medicalização e patologização da educação através de entrevistas com psicólogos da rede pública de saúde e coordenadores pedagógicos de escolas públicas focalizando a intervenção desses profissionais nas dificuldades apresentadas no processo ensino-aprendizagem. Medicalização e Patologização entendidas como um processo ideológico que transforma problemas sociais em doenças de indivíduos. Trabalhamos com a região norte do município de São Paulo. Os psicólogos entrevistados atuam em Unidades Básicas de Saúde e os coordenadores pedagógicos em escolas públicas de ensino infantil, fundamental e médio. O método utilizado foi o qualitativo, sendo as entrevistas conduzidas de acordo com o preconizado por José Bleger. A análise desenvolvida utiliza o referencial teórico de Grupos Operativos, tal qual formulado por Enrique Pichon-Rivière. Os resultados apresentados desvelam as dificuldades enfrentadas pelos profissionais no cotidiano de trabalho, principalmente no que tange à estrutura e dinâmica institucional e à formação acadêmica. Como consequência identificam-se processos de medicalização e patologização da educação. Aponta-se para a necessidade de revisão das políticas públicas e melhor instrumentalização teórica e técnica dos profissionais. Indica existir um pacto denegativo entre as instituições que garante a preservação da ordem estabelecida, evitando a crise que toda mudança carrega e, com isso, impedindo a transformação / This research aims to study the process of medicalization and pathologizing of education through interviews with psychologists in public health and coordinators of public schools focusing on the intervention of such professionals in the difficulties encountered in the teaching-learning process. Medicalization and pathologizing understood as an ideological process that transforms social problems in diseases of individuals. We work with the north region of the city of São Paulo. Psychologists interviewed worked in Basic Health Units and coordinators in public schools kindergarten, elementary and secondary. The method used was qualitative interviews were conducted in accordance with the recommendations by José Bleger. The analysis uses the theoretical Operational Group, as it formulated by Enrique Pichon-Rivière. The results presented reveal the difficulties faced by professionals in daily work, especially with regard to the structure and dynamics of institutional and academic. Consequently it identifies processes medicalization and pathologizing of education. Points to the need for revision of public policies and better exploitation of theoretical and technical professionals. Indicates there is a pact between denegativo institutions that guarantees the preservation of the established order, avoiding the crisis that all change loads and thereby preventing the transformation

A indagação do uso de psicofármacos no viver cotidiano foi o eixo disparador de experimentações que aconteceram em processos coletivos grupais - a partir da proposta da Gestão Autônoma da Medicação - com usuários de drogas psiquiátricas e trabalhadores de serviços de saúde pública, no período de quinze meses, em um CAPS Adulto, um CAPS Álcool e Drogas e duas UBS na cidade de São Paulo. A autonomia foi a questão norteadora e o critério permanente de conduta e análise de implicação nestes processos acompanhados segundo uma abordagem cartográfica. Os participantes foram convidados a ser pesquisadores que indagam, tateiam problemas e decidem os rumos da pesquisa em que o pesquisador acadêmico teve função de moderador e algumas vezes de apoiador de trabalhadores-moderadores. Nestes processos foram tratados diferentes focos de investigação: a epidemia das drogas psiquiátricas promovida pelo sistema de saúde; as tecnologias de saber e poder que constituem a experiência de doença e o lugar de paciente psiquiátrico; sintomas físicos e mentais produzidos com o uso de medicação; a violência do poder psiquiátrico contra a loucura e do racismo de Estado contra usuários de álcool e outras drogas; o estigma do inválido mental, a exclusão do mundo do trabalho e dificuldade de acesso aos direitos sociais; os efeitos da experiência de contração de grupalidade e da convivência no aumento da autonomia, potência de vida e redução de danos. Tais temas foram compostos coletivamente, num plano comum de experimentações intensivas, isto é, que aconteceram num regime de afetabilidade, de trânsitos e emergência de novas formas de agir e ser com o outro. / The investigation of the use of psychoactive drugs in everyday life was the triggering point for experiments that took place in collective group processes - based on the proposal of Autonomous Medication Management - with psychiatric drug users and public health service workers, in the period of fifteen months, in a psychosocial care center for adults, a psychosocial care center for alcohol and drug users and two units of primary health care, in São Paulo city. Autonomy was the guiding question and the permanent criterion of conduct and analysis of implication in these processes followed according to a cartographic perspective. Participants were invited to be researchers who inquire and decide the course of research in which the academic researcher has served as moderator and sometimes as a supporter of workermoderators. In these processes different research focuses were treated: the psychiatric drug epidemic promoted by the health system; the technologies of knowledge and power that constitute the experience of disease and the place of psychiatric patient; physical and mental symptoms produced with the use of medication; the violence of psychiatric power against madness and state racism against drug addicts; the stigma of the mental invalid, the exclusion of the access to work and the difficulty of access to social rights; the effects of the experience of group conviviality in the increase of the autonomy, potency of life and conduct of reduction of damages. Such themes were collectively composed in a common plan of intensive experiments, that is, they happened in a regime of affability, of transits and emergence of new ways of acting and being with the other.

Uma conjectura a respeito dos primeiros trabalhos de Michel Foucault marca uma opinião comum sobre a chamada arqueologia do saber: ela desenvolveria um método autorreferencial e semiestruturalista, bem como uma teoria sobre a sociedade que teria esvaziado o social. Por consequência, o surgimento da genealogia do poder adviria desse esgotamento teórico-metodológico da arqueologia. Não reconstruímos integralmente tais interpretações, mas a respeito delas assinalamos que uma adequada caracterização da arqueologia não pode prescindir da crítica intrínseca que ela traz. Este trabalho, portanto, pretendeu restituir à arqueologia de Foucault seu caráter crítico e político, a partir da determinação das condições de surgimento da genealogia do poder, demonstrando a total compatibilidade entre arqueologia e genealogia. Nossa hipótese geral foi a de que a arqueologia desfruta de caráter político, porque, no próprio desenvolvimento de condições históricas e de regras específicas do discurso, pode-se apreender a transformação das condições de existência e funcionamento dos discursos. Ora, a modificação dessas formações já é uma forma de ação política; logo, por nossa hipótese, não se deve perguntar qual prática política envolve a arqueologia, mas que avaliação pode ela fazer das transformações no modo de existência das formações discursivas. O objetivo deste trabalho foi, portanto, o de remontar a crítica arqueológica, sobretudo a crítica às ciências, tal como ela se estrutura nos primeiros trabalhos de Foucault. Para expressar de modo consistente a subversão crítica da concepção foucaultiana de arqueologia, escolhemos um itinerário. Deslocamos a crítica do saber médico para a analítica da finitude (História da loucura, Nascimento da clínica, e As palavras e as coisas); propusemos uma fundamentação teórico-prática das regras do discurso (Arqueologia do saber) e, por fim, fizemos da crítica arqueológica uma operação do conceito nietzschiano de vontade de verdade. / A conjecture constituted on Michel Foucaults first essays imprints a common opinion about the so-called knowledge archeology: it would not only develop a self-referent and semistructural method, but also a theory about the society that would have emptied the social. As a consequence, the emergence of powers genealogy would come from the theoreticmethodological exhaustion of the archeology. We havent reconstructed fully such interpretations, but concerning them, we signalize that an appropriate characterization of the archeology cannot be separated from the inherent criticism that carries it. Therefore, this thesis is meant to refund Foulcauts archeology its critical and political aspect, beginning with the determination of the genealogy powers emergence conditions, showing the complete suitability between archeology and genealogy. Our general hypothesis is that the archeology possesses a political feature because, in the development of speechs specific rules and existence conditions one can anticipate the transformation of existence conditions and speech operation. Nevertheless, the modification of these conformations has already the shape of a political action; therefore, according to our hypothesis, one should not ask which political experience implicates archeology, but what kind of evaluation can be done on the transformation of discursive conformations existence mode. Thus, the objective of this study is to rebuild archeological criticism mainly when its related to the criticism of Sciences, the way it is structured in Foucaults first essays. To express, in a consistent way, Foucaults archeological subversively critical concept, we have chosen an itinerary. We have dislocated medical knowledge criticism from finitude analytics (Madness and Civilization, The Birth of the Clinic e The Order of Things), offering a theoretical-practical grounding for the discourse rules (The Archaeology of Knowledge) and, lastly, from the archeological criticism weve created operation of Nietzsches will of truth concept.

RESUMO: Trata-se de uma pesquisa social realizada a partir de pressupostos da sociologia compreensiva em diálogo com autores das áreas da antropologia, psicanálise e psicologia social em que doze sujeitos apresentaram suas trajetórias e respectivos sentidos para o consumo de drogas lícitas e ilícitas em contextos privados. A partir de suas narrativas pôde-se compreender que o consumo de drogas relaciona-se diretamente com o contexto social na qual vivem os sujeitos, trazendo à tona aspectos morais, estéticos e sociais em seus usos. É possível afirmar como resultados da investigação: que a problemática do consumo de drogas envolve a excessiva medicalização e psiquiatrização de comportamentos, além de uma demasiada testagem entre os usuários de fármacos prescritos; a relação entre vulnerabilidade social e pobreza é um indicador superficial para a compreensão do consumo de drogas, em que a vulnerabilidade não está e não deve ser circunscrita à pobreza, e pessoas de camadas sociais mais favorecidas também fazem uso de drogas das mais diversas e por razões semelhantes àqueles que vivem em situação economicamente desfavorecida; a narrativa oriunda da comunidade científica no tratamento das drogas como um problema de saúde pública legitima o saber biomédico; o consumo do uso de drogas faz parte de um modo e estilo de vida contemporâneos para o alívio, anestesia e recreação de nosso tempo social; a produção de categorias científicas referentes aos usuários de drogas e aos seus estilos de vida acaba por transformar esse saber-poder em mercado para a comunidade científica e médico-jurídica; e, por fim, que o consumo de drogas não é um problema de saúde pública, a priori, principalmente, no que diz respeito ao uso das chamadas ilícitas, mas faz parte de um regime de moralidades. Nesse contexto, é o uso excessivo de fármacos prescritos e sua testagem em consumidores que devem ser olhados como problema de saúde pública, já o consumo de drogas ilícitas torna-se uma questão de saúde pública apenas na medida em que o usuário e/ou seu entorno justificam seu consumo como problemático a partir de uma construção social em que os saberes da medicina e da justiça tratam-no como sendo / ABSTRACT: This is a social research study based on the assumptions of interpretative sociology (Verstehen), in dialogue with authors from the areas of anthropology, psychoanalysis and social psychology, in which twelve subjects presented their personal histories and respective meanings in relation to the consumption of licit and illicit drugs in private contexts. From these narratives it was possible to comprehend that the consumption of drugs is directly related to the social context in which the subjects live, thereby bringing to light the moral, aesthetic and social aspects of their uses. It is possible to affirm the following results from the research: that the issue of drug consumption includes the excessive medicalization and psychiatrization of behaviors, in addition to excessive testing among users of prescribed drugs; the relationship between social vulnerability and poverty is a superficial indicator in the understanding of drug use, considering that vulnerability is not and should not be circumscribed to poverty since people from the most favored social strata also use a wide range of drugs for reasons similar to those of individuals in economically disadvantaged situations; the scientific community´s narrative in the treatment of drugs as a public health problem legitimizes biomedical knowledge; drug use exists as part of contemporary lifestyles and ways of life to provide relief, anesthesia and recreation during our social time; the production of scientific categories for drug users and their lifestyles ends up transforming this know-how into a market for the scientific and medical-legal community; and, finally, that drug use is not a public health problem a priori, especially with regard to the use of so-called illicit drugs, but exists within the context of a set of moral codes. In this context, it is the excessive use of prescription drugs and their testing on consumers that should be regarded as a public health problem, while the consumption of illicit drugs becomes a public health issue only to the extent that the user and/or his/her environment justify their consumption as \'problematic\' as a result of the social construction in which medical and legal knowledge considers them as such