O presente trabalho situa-se na interface entre os campos da EducaÃÃo e da Psicologia, propondo-se a cartografar prÃticas implicadas na produÃÃo do fracasso escolar e do âaluno-problemaâ. A problemÃtica da pesquisa surgiu a partir da atuaÃÃo da pesquisadora enquanto psicÃloga no contexto educacional, em que se deparou com queixas e demandas, advindas tanto dos educadores quanto dos familiares, sobre os âalunos-problemaâ: aqueles que possuem dificuldades de aprendizagem e nÃo avanÃam nos conteÃdos propostos ou aqueles que, de algum modo, apresentam uma inadaptabilidade Ãs rotinas de um cotidiano escolar. Desse modo, a pesquisa buscou analisar o cotidiano e o espaÃo escolar como lÃcus de produÃÃo do fracasso, discutindo como as prÃticas medicalizantes e o discurso do especialista atravessam o cotidiano de uma escola privada da cidade de ParnaÃba-PI. Por fim, procurou problematizar, juntamente com os professores e gestores da escola lÃcus, as prÃticas pedagÃgicas educacionais dos segmentos da EducaÃÃo Infantil e Ensino Fundamental I. A partir de uma perspectiva crÃtica e à luz dos estudos foucaultianos, a presente pesquisa traz a problemÃtica da medicalizaÃÃo da infÃncia e do fracasso escolar sob uma Ãtica histÃrica e social, distanciando-se do viÃs organicista e biologizante. Por isso, ganha sua relevÃncia ao discutir, de modo implicado, uma temÃtica que, cada vez mais, insere-se nos contextos educacionais, manifestando-se devido aos diversos transtornos relacionados à infÃncia. Tendo em vista o objeto e os objetivos traÃados, o estudo assumiu um viÃs qualitativo, utilizando-se da perspectiva da pesquisa-intervenÃÃo e adotando, para tanto, a cartografia como estratÃgia metodolÃgica e ethos de pesquisa. Cartografar prÃticas no espaÃo escolar significa acompanhar os processos que là se dÃo, observando os jogos de saber/poder, os discursos de verdade, as linhas de forÃa e as resistÃncias; que de algum modo atravessam esse cotidiano e relacionam-se com a produÃÃo do fracasso escolar e com a medicalizaÃÃo da vida. A pesquisa teve como participantes 12 profissionais da educaÃÃo que atuam nos segmentos da EducaÃÃo Infantil e Ensino Fundamental I (atà o 3 ano) da escola lÃcus. Para a produÃÃo dos dados foram realizadas observaÃÃes-participante e trÃs rodas de conversa. Os diÃrios de campo e as gravaÃÃes de Ãudio e vÃdeo serviram como ferramentas de registro dos dados produzidos. A partir dessas estratÃgias e ferramentas, foram evidenciadas questÃes que serviram como analisadores dos processos de produÃÃo do fracasso e medicalizaÃÃo da vida escolar. Essa produÃÃo se mostrou atravessada por mÃltiplos vetores como: prÃticas pedagÃgicas, condiÃÃes de trabalho docente, contexto social e familiar das crianÃas e a presenÃa do especialista e discurso mÃdico psicolÃgico no espaÃo escolar. Apesar disso, tambÃm se rastrearam discursos e prÃticas, ainda tÃmidos, que escapavam Ãqueles instituÃdos, abrindo passagem para que devires e singularizaÃÃes pudessem se expressar e ocorrer. Espera-se que esta cartografia possa contribuir com a produÃÃo de novos agenciamentos e novas prÃticas no espaÃo escolar. / This study is between two areas, Education and Psychology, aiming to map practices related to the production of school failure and the âproblem studentâ. The research problem emerged from the researcher actuation as psychologist in educational context. There she had contact with complaints and demands that came from educators and families about the âproblem studentsâ: those who have learning disabilities and donât move forward on the proposed content or those who, in some way, donât adapt to schoolâs routine. Therefore, the research aimed to analyze schoolâs space and routine as locus of failure production, deliberating how medical practices and the expert speech pass through daily life of a private school in ParnaÃba city, PiauÃ. Lastly, it aimed to think with schoolâs teachers and managers about pedagogical practices of Preschool Education and Elementary School. From a critical view and enlightened by Foucault studies, this research deals with childhood medicalization and school failure under a social and historical view, pulling away from an organic and biological interpretations. Thatâs why the research is relevant, by discussing, in an involved way, a theme thatâs entering increasingly in school contexts, through many disorders related to childhood. Take into account itsâ object and purposes, this study has a qualitative view, using intervention research and adopting cartography as methodological strategy and researchâs ethos. Mapping practices in school space means accompany processes that happen there, observing know/power games, truth speeches, force lines, resistances; that in some way cross schools routine and are related to the school failure production and life medicalization. The research had as participants 12 education workers that act in Preschool and Elementary School (until Brazilian 3 year) at theschool that is locus on this research. To data creation it was realized participant-observations and three conversation circles. Fields journal and video and audios recording were used as register for the produced data. From these instruments and strategies, questions were emphasized. These questions served as analyzing tools for the production processes of failure and schoolâs life medicalization. It was noticed that this production is crossed by many vectors, such as: pedagogical practices, teacherâs labor conditions, childrenâs family and social context, the expert presence and psychological and medical speech in schoolâs space. Nevertheless, it was also traced shy speeches and practices that were different from those vested speeches, opening space for the expression of singularities. It is expected that this cartography is able to help with new assemblage production and new practices in schoolâs context.

Nesta pesquisa pretendemos demonstrar que o processo de patologização e medicalização da infância não é um fenômeno isolado nem tampouco recente, mas está profundamente enredado a diversos fatores históricos e contemporâneos. Neste sentido, o esforço para compreender os fatores que o antecederam nos permitiu identificar sua filiação ao processo de medicalização do espaço social, iniciado ainda no século XIX, que estabeleceu a saúde da criança escolarizada como um de seus principais objetivos. Sua vinculação às (re)formulações conceituais produzidas pelos postulados psiquiátricos e psicopatológicos no campo da chamada saúde mental, principalmente a partir da publicação, em 1980, da terceira edição do Manual Diagnóstico e Estatístico de Transtornos Mentais (DSM-III). E sua forte expansão a partir da parceira estabelecida entre setores da psiquiatria e as indústrias farmacêuticas transnacionais, empenhada em massificar a produção e o consumo dos psicofármacos. Com relação à conjuntura propriamente contemporânea, concluímos que este processo também se conecta a questões que são muito características desta cultura tecnocientífica e consumista na qual estamos todos inseridos. Onde, considera-se que ao invés de investigarmos as questões familiares, escolares etc. para podermos entender o que de fato está se passando com as crianças que apresentam dificuldades em suas aprendizagens e/ou comportamentos, deveríamos admitir que estes sintomas seriam decorrentes de um transtorno (neuro)psiquiátrico, cuja resposta mais efetiva para tratá-lo seria através do consumo de psicofármacos. / In this research we intend to demonstrate that the process of pathologization and medicalization of childhood is not an isolated nor recent phenomenon, but is deeply entangled to the various historical and contemporary factors. In this sense, the effort to understand the factors that preceded it allowed us to identify their affiliation to the medicalization process of social space, already started in the nineteenth century, which established the health of school-age children as one of its main objectives. Their relation to conceptual (re)formulations produced by the psychiatric and psychopathological postulates in the field of so-called mental health, especially since the publication in 1980 of the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III). And its strong expansion from the partnership established between sectors of psychiatry and the transnational pharmaceutical companies, committed to popularize the production and consumption of psychotropic drugs. With respect to proper contemporary context, we conclude that this process also connects to issues that are very characteristic of this techno-scientific and consumer culture in which we are all inserted. Where, it is considered that rather than investigating about the family, school etc. issues to understand what is going on with children in their learning and/or behavior difficulties, we should admit that these symptoms would be due to a (neuro)psychiatric disorder, whose most effective response to treat it would be through the use of psychotropic drugs.

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

Este trabalho analisa as mudanças na forma de administrar a saúde pública na cidade de São Paulo no início do século XIX, momento em que se iniciava a preocupação pública com o prolongamento da vida e saúde da população para o crescimento econômico dos países da Europa e América. No Brasil, também nessa época, a administração colonial se transformou em administração local, devido à independência. Em São Paulo, a preocupação com a saúde pública foi traduzida, na prática, como a necessidade de aformoseamento da cidade (proibição de despejos, limpeza de ruas), dessecamento de pântanos, extermínio de formigas e também vacinação contra a varíola. Tal medicalização da cidade se iniciou entre 1819 e 1822, período em que se passou a exigir a limpeza constante do espaço público, e não mais apenas nas ocasiões das festividades religiosas e políticas. Essa medida passava a assumir uma feição utilitária de cuidado com a saúde e não mais apenas uma demonstração de nobreza. À exceção da profilaxia contra a varíola, a administração local teve como meta garantir a saúde dos grupos economicamente superiores da cidade, uma vez que a manutenção da salubridade do local era realizada com a utilização do trabalho de grupos sociais que deveriam passar pelos locais de maior contágio da cidade: a cadeia e a senzala. Tanto os escravos quanto os presos eram usados como mão de obra de limpeza do espaço urbano, conserto de ruas e dessecamento de pântanos. A vida desses grupos era curta, uma vez que somavam-se lepra, varíola e sarampo (doenças sempre presentes na cadeia) ao trabalho forçado e às condições de subnutrição impostas pelo cativeiro aos escravos e falta de alimentação aos presos. Entretanto, era por meio da circulação de homens sob essas circunstâncias que se assegurava a saúde pública em São Paulo, ou seja, era por meio do sacrifício de determinados grupos que se buscava a salubridade da atmosfera, vista como fator imprescindível para a manutenção da vida. Portanto, tratou-se de uma ideia de sanitarismo bastante distinta daquela esboçada pelos primeiros sanitaristas franceses, cujo principal objetivo era assegurar o prolongamento da vida da classe trabalhadora. / This thesis analyzes the changes in the form of administrating the public health in the early 19th century Sao Paulo, when the public concern with the prolongation of life and health of the population aiming at the economic growth of the countries of Europe and America started. In Brazil, also at this time, the colonial administration became local administration, due to the national independence. In Sao Paulo, the concern about public health was translated into practice as the need for embellishment of the city (prohibition of dumping, street cleaning), draining of swamps, ant extermination and vaccination against smallpox. Such medicalization of the city began between 1819 and 1822, when street cleaning became an obligation, and no longer only a requirement in occasion of political and religious festivities. This measure started to have a utilitarian feature of health care, and no longer just a display of nobility. Apart from the prophylaxis against smallpox, the local administration aimed at ensuring the health of affluent groups of the city, since the maintenance of salubrity of the areas was carried out with the use of the work of social groups that were supposed to pass through the citys largest contagious spots: the prison and the senzala (slave house). Both slaves and prisoners labor were used to the cleaning of urban space, repairing of streets and draining of swamps. The life of these groups was short, due to leprosy, smallpox and measles (diseases always present in jail), forced labor and malnutrition conditions imposed by captivity and the usual privation of food to prisoners. However, the public health was ensured by the circulation of men under those circumstances, that is, the salubrity of the atmosphere could be guaranteed through the sacrifice of certain groups, being salubrity seen as an essential factor for the maintenance of life. Therefore, it was an idea of sanitarism quite distinct from that outlined by the first French health professionals, whose main objective was to ensure the prolongation of life of the working class.

Submitted by Jorge Silva (jorgelmsilva@ufrrj.br) on 2018-05-09T18:59:45Z No. of bitstreams: 1 2017 - L?via Machado da Silva.pdf: 778718 bytes, checksum: aeb1a000f93e81ee6aec1f869d6990c0 (MD5) / Made available in DSpace on 2018-05-09T18:59:45Z (GMT). No. of bitstreams: 1 2017 - L?via Machado da Silva.pdf: 778718 bytes, checksum: aeb1a000f93e81ee6aec1f869d6990c0 (MD5) Previous issue date: 2017-07-12 / CAPES / This work seeks to discuss the issue of teacher illness in light of the definition of medicalization of life proposed by Conrad (1992, 2007). For the author, this is a process in which everyday instances of life come to be claimed by the discourse of medicine, generally adopting diagnostic terms. Burnout syndrome is used as the conceptual operator due to the emergence of studies that associate this syndrome with the educational context. In the bibliographic review the researches on the topic of medicalization and Burnout Syndrome in the teaching category are highlighted. There is no consensus in the literature regarding the concept of medicalization, so that Conrad's perspective is privileged to highlight the sociocultural role. The context of the teaching sickness is problematized through works that discuss the historical changes occurred in the Brazilian educational scene, besides addressing the social and political influences on the work. Particular emphasis is given to the issue of neoliberalism and how it has contributed to new forms of relationship in the world of work. From the foucaultian perspective, the manifestation of Burnout is analyzed with the constituency of the teacher in the network of power relations, contextualizing its environment, marked by the social, political, economic and historical events of contemporary western society. Finally, the phenomenon of teaching sickness is taken as an analyzer of the present modes of subjectivation, praising the possibility of this being taken as resistance. / Este trabalho busca discutir o tema do adoecimento docente ? luz da defini??o de medicaliza??o da vida proposta por Conrad (1992; 2007). Para o autor, este ? um processo no qual inst?ncias cotidianas da vida passam a ser reivindicadas pelo discurso da medicina, geralmente adotando-se termos diagn?sticos. Utiliza-se como operador conceitual a S?ndrome de Burnout devido ? emerg?ncia de trabalhos que associam tal s?ndrome ao contexto educacional. Na revis?o bibliogr?fica s?o destacadas as pesquisas em torno do tema da medicaliza??o e da S?ndrome de Burnout na categoria docente. N?o h? um consenso na literatura a respeito do conceito de medicaliza??o, de modo que a perspectiva de Conrad ? privilegiada por evidenciar o papel sociocultural. O contexto do adoecimento docente ? problematizado atrav?s de trabalhos que discutem as mudan?as hist?ricas ocorridas no cen?rio educacional brasileiro, al?m de abordar a respeito das influ?ncias sociais e pol?ticas sobre o trabalho. D?-se especial destaque ? quest?o do neoliberalismo e como ele contribuiu para as novas formas de rela??o no mundo do trabalho. A partir da perspectiva foucaultiana, a manifesta??o do Burnout ? analisada com a circunscri??o do professor na rede de rela??es de poder, contextualizando o seu meio, marcado que ? pelos eventos sociais, pol?ticos, econ?micos e hist?ricos da sociedade ocidental contempor?nea. Por fim, o fen?meno do adoecimento docente ? tomado como analisador dos atuais modos de subjetiva??o, enaltecendo a possibilidade deste ser tomado como resist?ncia.

A educação, como laço discursivo, constitui-se a partir de discursos que guiam, de maneira geral, seus saberes e práticas. Destacamos aqui, como hegemônicos, o discurso (psico)pedagógico (Lajonquière, 1997; 1998a; 1998b; 1998c; 1999), discurso que professa saberes e crenças acerca da educação profundamente atravessados por conhecimentos e ilusões da psicologia, e aquele nomeado por autoras como Moysés e Collares (1994; 1997; 2013) discurso medicalizante. Destes discursos decorrem inúmeras implicações ao educador, ao sujeito aprendiz e àquilo que se passa no ato educativo. O pedagogo ou professor dá um passo para trás e cede espaço a alguém que fala como especialista: detentores de saberes médicos e psi, autorizados a discorrer acerca da normalidade ou anormalidade de determinados comportamentos do sujeito-aluno. Profundamente enraizados em saberes científicos, estes discursos carregam em si marcas e características que podem ser entendidas como estruturais ao que compreendemos por ciência. Dentre elas, destaca-se a intenção de situar na ordem do controlável, mensurável, previsível seu objeto de estudo; ou, neste caso, seu sujeito-objeto (Imbert, 2001). Identificados estes sujeitos, a educação teria meios para intervir da maneira mais ajustada e adequada possível à demanda daqueles que aprendem, podendo assim controlar os resultados destas intervenções. Para isso, além de conhecimentos que fundamentam as práticas educativas, a pedagogia, pautada em saberes advindos da psicologia e da medicina, fornece à educação instrumentos testes, métodos, avaliações, laudos para auxiliar neste reconhecimento e mapeamento dos sujeitos. Imersa nestes discursos que caminham no sentido de uma normatização dos sujeitos, a educação, bem como os educadores, torna-se instituição reguladora do desenvolvimento normal, ideal. Como era de se esperar, do caos das singularidades emergem alunos que se deslocam em sentido contrário àquele esperado ao desenvolvimento normal e não se ajustam ao previsto. Diante destes alunos desviantes surge a necessidade de que sejam encaminhados a especialistas capazes de dar as respostas que a eles faltam. No retorno à escola, o sujeito carrega consigo algo que, aos olhos do discurso (psico)pedagógico e medicalizante, é capaz de dizer com precisão quem é este sujeito e de que se trata aquilo que surge como desviante: o laudo. Diante disso, busca-se aqui uma reflexão acerca das implicações que o conjunto de saberes, instrumentos e ilusões veiculadas por estes discursos acarretam ao professor, ao sujeito aprendiz e ao ato educativo. / Education, as a discursive bonding, is constituted from discourses that guide, in general, their knowledge and practices. We highlight here, like hegemonic, the (psycho)pedagogical discourse (Lajonquière, 1997; 1998a; 1998b; 1998c; 1999), discourse that profess knowledge and beliefs about education deeply crossed by knowledge and illusions of psychology, and that named by authors like Moyses and Collares (1994; 1997; 2013) medical discourse. From these discourses, there are innumerable implications for the educator, the apprentice subject and what happens in the educational act. The pedagogue or teacher takes a step back and gives way to someone who speaks as a specialist: holders of medical knowledge and \"psy\", authorized to comment about the normality or abnormality of certain behavior of the subject-student. Deeply rooted in scientific knowledge, these discourses carry within themselves marks and characteristics that can be understood as structural to what we understand by science. Among them, highlights the intention to place in the order of the controllable, measurable, predictable its object of study; or, in this case, its subject-object (Imbert, 2001). Once these subjects were identified, education would have the means to intervene in the most appropriate and adequate way possible to the demand of those who learn, thus being able to control the results of these interventions. To this end, in addition to the knowledge that underlies educational practices, pedagogy, based on knowledge derived from psychology and medicine, provides education with instruments - tests, methods, evaluations, reports - to help in this recognition and mapping of subjects. Immersed in these discourses that move toward a normalization of the subjects, education, as well as educators, becomes the regulating institution of normal, ideal development. Unsurprisingly, from the chaos of singularities emerge students who move in the opposite direction to that expected - to normal development - and do not fit the predicted. In the face of these deviant students, the need arises to be referred to specialists capable of giving the answers they lack. On returning to school, the subject carries with him something that, in the eyes of the (psycho)pedagogical and medicalizing discourse, is able to say with precision who this subject is and what is deviant: the report. In this way, we aim to propose a reflection about the implications of that set of knowledge, instruments and illusions conveyed by these discourses to the teacher, the apprentice subject and the educational act.

La prison fait l’objet d’un nombre croissant de publications biomédicales depuis les années 1980, en France, comme dans la plupart des pays occidentaux industrialisés, mettant l’accent sur les prévalences élevées de certaines affections chroniques parmi la population carcérale. Comment se fait-il que tant de personnes emprisonnées ont des « problèmes » de « santé » ? Cette thèse entreprend de répondre à cette question en appréhendant la santé non pas comme un état, mais comme une norme. À partir d’une enquête ethnographique associant observations de pratiques judiciaires, monographies des services médicaux d’établissements pénitentiaires, entretiens, statistiques et étude de corpus d’articles scientifiques, elle s’attache à montrer, pas-à-pas, selon une approche processuelle, comment la chaîne pénale produit des « malades » en confrontant les individus saisis par ses dispositifs à des normes de santé et à des savoirs médicaux. À la croisée d’une sociologie des institutions, d’une sociologie de la médecine et d’une sociologie de la connaissance, en étant à la fois attentive à des pratiques bureaucratiques, à la construction de décisions (pénales, gestionnaires et médicales), aux conditions concrètes de réalisation d’études biomédicales en maison d’arrêt et à leurs effets, à des rhétoriques judiciaires et scientifiques, aux activités professionnelles qui constituent le soin en prison et à l’appropriation socialement différenciée de ce travail par les détenus, l’enquête permet de comprendre comment le pouvoir médical se déploie, au présent, de façon discrète et diffuse, dans et par des institutions ne se donnant pas pour première mission de soigner. / In France, as in most Western countries, prison has been the subject of a growing number of biomedical publications since the 1980s that emphasize the high prevalence of certain chronic conditions among the prison population. Why do so many prisoners have “health” “problems”? This dissertation undertakes to answer this question by approaching health not as a state, but as a norm. At the intersection of the sociology of institutions, the sociology of medicine and the sociology of knowledge, it draws on an ethnographic study combining observations of judicial practices, monographs of prison medical services, interviews, statistics and analyses of scholarly articles. Through a processual approach, it shows how the penal system produces “ill persons” by confronting the individuals caught by its devices with health norms and medical knowledge. By attending to the bureaucratic practices, to the construction of (criminal, managerial and medical) decisions, to the concrete conditions under which biomedical studies are conducted in prison as well as their effects, to the judicial and scientific discourses, to care activities and to the appropriation of such care by prisoners according to their social background, the present investigation allows for an understanding of how medical power currently unfolds, in a discreet and diffuse fashion, in and by institutions that do not primarily mean to cure.

<p>In this dissertation, I study medicalization, a wide spread phenomenon in this world but understudied in the current literature. The main theoretical focus of this dissertation is on expanding the medicalization theories. Questioning the breadth of conceptualization, the feasibility of measurement, and the depth of empirical implications in the extant medicalization theories, this dissertation proposes a new conceptual model of medicalization and further develops a quantitative measure of medicalization by disaggregating it into empirically valid dimensions that could be used to examine how degree of medicalization is related to social outcomes. Specifically, I conceptualize medicalization as an institutionalization process whereby the medical model becomes increasingly dominant in the explanation of health, illness, and other human problems and behavior. Medicalization is multidimensional and is represented by expansions in the three major components of the health care system: increasing medical investment, medical professionalization/specialization, and the relative size of the pharmaceutical industry. </p><p>Based on this new conceptual model and measurement, I probe three research questions: (1) how medicalization may impact population health in the context of recent epidemiologic transitions and how this impact may differ by the stages of epidemiologic transition and socioeconomic development; (2) what are the mechanisms that reproduce medicalization; and (3) how the lay public may respond to medicalization, the institution of medicine, and the medical profession.</p><p>This dissertation links several lines of theoretical and empirical research from medical sociology, demography, epidemiology, health economics and management, and medical science, and extensively employs OECD Health Data, World Development Indicators, the World Values Survey, the European Values Study data, the U.S. General Social Survey, and the U.S. National Health Interview Survey. It uses several advanced statistical methods, e.g., multiple imputations, latent variable analysis, mixed models, generalized estimating equations models, generalized method of moments models, difference-in-difference models, and hierarchical-age-period-cohort models.</p><p>Results for the first research question suggest that various dimensions of medicalization vary in importance on population health and these effects also differ by the stages of epidemiologic transition and socioeconomic development. I discuss the mechanisms linking various dimensions of medicalization to population health and then discuss these findings in the context of epidemiologic transition, fundamental causes of disease and death, and global health movement. </p><p>Results for the second research question suggest that medicalization at both the societal and individual levels negatively affect individual subjective health, which leads to increasing health care utilization. These social processes function together to promote and reproduce medicalization at societal level. I discuss several pathways linking medicalization to lower subjective health and other agents of medicalization.</p><p>Results for the third research question suggest that American's "confidence in the medical institution and profession" has continuously declined in the last three decades and groups with higher socioeconomic status report lower obedience to doctors' authority, but are more likely to trust doctors' ethics than their counterparts. I discuss the mechanisms for the changes in public confidence in the medical institution and profession, the status of medicine and the medical profession in the era of medicalization, the paradox of opposite trends in attitudes toward medicine and health utilization behavior, and group differences in obedience and trust.</p> / Dissertation

Postpartum Depression: Standardizing Motherhood? by Pamela J. Regus Under the Direction of Wendy S. Simonds ABSTRACT An expansion of the medicalization of Postpartum Depression (PPD) is evident in increased screening for maternal depression that begins in pregnancy and continues in the postpartum period, and in the growing number of medical professionals alerted to watch for signs of maternal distress. Although a definitive etiology ofPPDremains elusive, the scientific and medical fields – highly imbued with authority to create knowledge in Western society – promote essentialist views of motherhood that espouse “natural” attributes such as maternal instincts and tendencies to nurture. Mothers who struggle with these standards of motherhood are then defined as being ill and become patients under the care of the medical profession until they can perform adequately in their motherhood roles, or they face social condemnation and legal repercussions for being “bad” mothers. Because characteristics of the “normal” postpartum period are said to be similar to symptoms of general depression, how do some women come to identify their postpartum experiences as depression while others do not? Does the choice of traditional obstetrics or an alternative, such as midwifery, make a difference in the incidence of postpartum depression? And what changes in the social support network occur in a woman’s life as a result of a diagnosis ofPPD? Using Foucault’s theory of docility, critical constructionism, and postmodern feminism as the theoretical focus, and in-depth interviews as the research method, I compare the postpartum experiences of mothers who have been diagnosed with postpartum depression with mothers who have not been diagnosed. The sample includes mothers who gave birth with the assistance of obstetrics and mothers who gave birth with the assistance of certified nurse-midwives. In order to examine the differences in approaches to and treatment of postpartum depression, I also interview a sample of obstetricians and certified nurse-midwives. Findings show that medical professionals use gender-normative assessments, such as physical appearance, language, and nurturing tendencies to determine whether the mother is performing as expected; if not, she is defined as ill and treated with antidepressant medication. Although the majority of mothers in the sample experienced feelings of depression in the postpartum period, many resisted diagnosis and medication. Mothers found the greatest support in their peers, rather than those closest to them, citing the ability to talk candidly about the struggles they face in their motherhood roles as the way to avert or heal from PPD. This finding highlights the enforcement of normative motherhood within the social institutions of the family and medicine; thus, cultural change from ideological representations of motherhood may come about through peer relationships. INDEX WORDS: Postpartum depression, Motherhood, Medicalization, Expansion of medical control, Maternal behavior, Childbearing years, Normative motherhood

In this study, I conduct a multiple method content analysis of literature on postpartum depression (PPD) from two on-line sources, Medline and LexisNexis. The purpose of the study is to determine how the medical profession defines and frames PPD, and to consider the implications of its movement into the medical model. I use the theories of Foucault, Gramsci, critical constructionism, and postmodern feminism to examine the effect of the medicalization of PPD on women’s lives. Using both simple descriptive statistics and qualitative analysis, I show the expansion of medical control over women’s bodies in the childbearing years beyond the physical to include the emotional and psychological aspects as well, which results in standardized maternal behaviors and emotions that tighten the boundaries of motherhood.