Breastfeeding support for mothers and their babies historically was the informal work of family and community members. In the United States today, breastfeeding support is embedded in the biomedical system, and is provided by a new allied health professional: the International Board Certified Lactation Consultant (IBCLC). This dissertation explores this professionalization of breastfeeding support and the origins of this new profession. It studies how IBCLCs working in the U.S. cultural context perceive and practice the profession and examines the relationship between the profession of lactation consulting and the medicalization of breastfeeding. Oral history interviews with 17 founders of the profession, which was established in 1985, and a content analysis of the professional journal (the Journal of Human Lactation) from 1985 to 2010, allowed me to build the story of how and why breastfeeding support became professionalized and how experiential breastfeeding knowledge entered the domain of expert knowledge. While constrained by the biomedical system in which they created the profession, the founders exhibited a both agency and creativity in their production and reproduction of professional values and practices. Interviews with 30 currently certified IBCLCs and observations of the clinical practice of 3 IBCLCs provided insight into the daily practice of IBCLCs working in different settings--hospitals, WIC clinics, pediatric offices, and private practice. The data collected from these ethnographic methods demonstrated how the medical knowledge base of IBCLCs translates into clinical practice with patients, and allowed me to understand the relationship between the profession of lactation consulting and the medicalization of breastfeeding. While IBCLCs' draw on medicalized knowledge and evidence about breastfeeding and human lactation, their interactions with clients are best described as empathetic and humanistic, and are derived from nursing and mother-to-mother breastfeeding support models rather than from a technocratic, biomedical approach to care. While the appropriation of certain biomedical values and standards helped to legitimize the professionalization efforts of the founders, in practice, lactation consultants apply their medical knowledge and clinical experience in a way that reflects the compassionate, empowering care approach of mother-to-mother breastfeeding support and that thus resists the overt medicalization of breastfeeding.

The purpose of this research is to examine the institutional narrative of substance use disorders (SUDs) in the U.S. military and the extent to which it reflects the medicalization process. Three general research questions guided my analysis of the narrative surrounding SUDs in the military: (1) How does the military characterize the problems and resolutions of SUDs? (2) How and to what extent does this narrative reflect medicalization? (3) What are the limitations inherent in the institutional narrative of SUDs in the military? In order to address these questions, I draw on three conceptual lenses: (1) The work of Loseke (2007) and others on the powers of institutional narratives; (2) The work of Conrad and Schneider (1980) in which they propose that medicalization can be understood in multiple ways and on at least three distinct levels (the conceptual, the institutional, and the interactive); and (3) The work of disability scholars on the limitations of the medical model and the importance of adopting a social model of the causes and consequences of disability (Oliver and Barnes 2012; Shakespeare 2014; Berger 2012). In this study, I use these lenses to conduct a textual analysis of the VA/DoD Clinical Practice Guideline for Management of Substance Use Disorders. This manual was developed under the auspices of the Veterans Health Administration (VHA) and the Department of Defense (DoD) pursuant to directives from the Department of Veteran Affairs (VA). The document was designed to provide recommendations for the performance or exclusion of specific procedures or services related to identification and response to substance use among active duty personnel and veterans in all branches of the US military. The information and recommendations presented in the document were then disseminated throughout all branches of the military for implementation. This document is, therefore, a powerful codification of the institutional narrative of substance use in the military. Using Conrad and Schneider’s model as a template (1980), I examined the document in order to see how the military has framed the discussion surrounding SUDs. My analysis began with a close reading of the manual several times without much reflection in order to get a general feeling for the story being constructed by the text. However, as I continued with the close reading, I began making comments about the practices and overall impressions the manual puts forth. After several readings and thorough note taking, it became clear that there was a significant amount of medicalization occurring throughout the military manual, and evidence for medicalization could be seen on all three of the levels suggested by Conrad and Schneider. Words and phrases of text were eventually coded and categorized into the three levels of medicalization. The narrative within the document depicts a specific story of how the military addresses matters involving SUDs through a system of screening, assessment and treatment. First, the document’s language relating to diagnostic assessments, laboratory biomarkers and other screening devices used to categorize and measure one’s substance use can all be considered evidence for medicalization at the conceptual level. Multiple segments of text have been identified and categorized on a conceptual level. Second, clear indications of medicalization on the institutional level can be seen with references to specialty treatment, “specialty care” and “other clinics.” Again, multiple text segments have been identified as being representative of medicalization at the institutional level. Finally, evidence for interactive medicalization can be seen through the use of medical referrals, pharmacological treatments and the ongoing monitoring of medical consequences of substance use. The findings suggest that the military has adopted what many now consider a medical model approach toward understanding substance use and evidence can be found at all three levels of medicalization proposed by Conrad and Schneider. Strengths and weaknesses of exclusive reliance on a medicalized narrative of the causes of substance use among military personnel and veterans are discussed in light of the lessons learned from the social model of disability and other critiques of medicalization. I conclude that the success of a medicalized response to substance use may be hampered by the tension between the two widely circulating cultural narratives that intersect in the case of substance use among military personnel.

This dissertation explores the British colonial government’s attempt to reconstruct women’s reproductive behaviors in colonial Ghana through the sites of maternal and infant welfare services and western midwifery education. In the early 1920s, the fear that the high maternal and infant mortality rates in the Gold Coast would have repercussive effects on economic productivity caused the colonial government to increasingly subject women’s reproduction to medical scrutiny and institutional care. I argue that female reproduction was selected as a site of intervention because the British colonial government conceived of it as a path of least resistance to social reconstruction, economic security, and political dominance. The five chapters have been designed to analyze colonial reproductive intervention as a socio-economic and political exigency of colonial rule. This dissertation speaks to the fact that cross-culturally, the female body has been politicized through narratives of power, culture, tradition, modernity, race, disempowerment, and empowerment. / text

This thesis explores the subject positions available to users of genetic tests for bipolar disorder in the United States. In advanced liberal societies, tests for genetic susceptibility to complex disorders may be promoted and used as means of performing responsible citizenship through the consumption of health care services. In the context of mental illness, however, key assumptions about the characteristics of consumers may not be met. The research found that because the category of “potential test user” substantially overlaps with the category of “mental health care user,” both the rationality and autonomy of these individuals is subject to question. Test users are framed in relational terms: as family members, as patients, and as consumers – but the last of these relational frames is considered problematic. Therefore, while the tests are framed as tools for proactive health management, responsibilities surrounding their use are largely allocated to family members and doctors.

No description available.

The goal of this study is to critically examine health information sources in order to determine whether Aboriginal women are represented in these resources, and if so, how they are being presented. This research is intended to illuminate the practices around the construction of information, and to demonstrate that the manners in which information is conveyed can be problematic. To accomplish these goals, critical discourse analysis was utilized to explore both consumer health publications available to pregnant women in Edmonton, Alberta, as well as academic publications available to students and healthcare providers through the University of Alberta Libraries. Through this critical analysis of these resources, it is clear that information is being constructed in a manner that supports neocolonial practices and reinforces negative stereotypes of Aboriginal women. The analysis of these sources also demonstrates ways in which information can be constructed more appropriately, to avoid racializing tendencies.

Thesis (M.A.)--Miami University, Dept. of Psychology, 2006. / Title from first page of PDF document. Includes bibliographical references (p. 44-56).

A vigente política brasileira sobre drogas aloca, aos que as consomem ou aos que as comercializam, ao patamar da ilegalidade – ainda que preveja a diferenciação de fronteiras imprecisas, entre consumo e tráfico. A conjuntura proibicionista proporciona a existência de complexas redes sociais, entre os que mais lucram, e não são identificados como tais, e os que são passíveis de punição/correção. Estes últimos são os que se encontram na porção final da rede de vendas de drogas, em geral ocupada por jovens pobres, fato denunciado no contexto das medidas socioeducativas descritas por este trabalho. Esta dissertação é o resultado de um processo cartográfico junto a jovens em cumprimento de medidas socioeducativas em meio aberto por envolvimento no comércio de drogas, a partir da inserção em grupos de Prestação de Serviços à Comunidade e de Liberdade Assistida. Apresento aqui os elementos vivenciados no período da pesquisa, relacionando-os com as noções de criminalização das juventudes, biopoder e de medicalização do social, analisando como estes se expressam na contemporaneidade e como são trabalhados e (re)produzidos no contexto socioeducativo. Demonstrar como estes conceitos se articulam e constituem a produção de discursos na relação com jovens envolvidos/as com a rede de comércio de drogas, com as políticas públicas para crianças e jovens ao longo do tempo e com as instituições responsáveis pelas medidas socioeducativas em meio aberto foram as pistas percorridas por esta cartografia. Neste contexto é coerente questionar, serão os jovens que estão em conflito com as leis, ou as leis que estão em conflito com os jovens? / The current Brazilian substance misuse policy allocates to those who consume or to those who sell, the illegality – although providing a differentiation, yet of blurred boundaries between consumption and trafficking. The prohibitionist scenario provides the existence of complex social networks among those who profit from, and are not identified as such, and of those whom are punishable. The latter are those who are in the final portion of the drug sales network, generally occupied by poor young people, a fact reported in the context of socio-educational measures described in this work. This dissertation is the result of a social cartography process with young people in fulfilment of educational measures for involvement in the drug trade, part of the integration in Service Delivery groups to Community and Assisted Freedom. I present here the experiences during the research period, relating them to the criminalization of youths, biopower and the medicalization of social, analyzing how these are expressed in contemporary society and how they are worked out and (re)produced in the social and educational context. To demonstrate how these concepts are linked and constitute the production of discourse in relation to young people involved with the drug trade network, with public policies for children and young people over time and with the institutions responsible for social and educational measures were the hints used by this cartography. In this context it is relevant to question: is it the youths who are in conflict with the laws, or are the laws in conflict with the youths?

Ancorado nas discussões teóricas acerca do tema da medicalização e nas pesquisas brasileiras que apontam para o aumento, no país, do consumo do psicofármaco comercialmente chamado Ritalina®, este trabalho tem como objetivo refletir sobre o papel atribuído a esse fármaco na forma como seus consumidores compreendem e constroem a si mesmos, especialmente no que tange à crença cultural no auto-aperfeiçoamento. Os dados empíricos que embasam a discussão aqui proposta foram produzidos através de entrevistas com pessoas que utilizavam a medicação e também por meio da análise do material de divulgação da Ritalina®, que é voltado ao público especializado. Busca ressaltar, assim, a importância de pesquisas sobre a imaginação farmacêutica relacionada a esse medicamento, no que se refere à existência de discursos que destacam valores a respeito de desempenho, concentração e controle. Por fim, são apresentadas justificativas e práticas de utilização que perpassam questões acerca da normalização, tratamento e melhorias de si, bem como se problematiza a existência da categoria de aprimoramento intitulada aprimoramento circunstancial. / Based on theoretical discussions about medicalization and on Brazilian researches that point out to an increase in the consumption of the psychotropic medication commercially known as Ritalin®, the present work aims to reflect on the role accredited to this drug in the way its consumers comprehend and construct themselves, especially regarding a cultural believe in self-enhancement. The empirical data that support the presented discussion was gathered through interviews conducted with people that have used the medication, and also through an analysis of Ritalin’s® advertising material directed to an audience of specialists. Thus, it aspires to call attention to the importance of researches on pharmaceutical imagination, as regards the existence of speeches that highlight values regarding performance, concentration and control. Finally, it presents usages justifications and practices that engage issues regarding normalization, treatment and self - improvement, and at the same time it problematizes the existence of an enhancement category termed as circumstantial enhancement.

As políticas sociais de educação e saúde constituem campos de ação e conhecimento de relevância pública e estratégica, tendo em vista seus reflexos na qualidade de vida da população brasileira. Como direitos sociais, expressam disputas políticas e são instâncias de intervenção direta do poder público estatal e da sociedade, no entrecruzamento das necessidades sociais, demandadas pela população, e suas formas de atendimento e custeio, geridas pelo Estado. A escola e os programas de saúde são instrumentos de execução direta destas políticas, tendo como principal função torná-las acessíveis à população, por meio de seus serviços. Na tese estudam-se as relações interinstitucionais estabelecidas entre o Programa de Saúde escolar e as escolas do município de Porto Alegre nas configurações de suas demandas por atendimento e em seus fluxos de encaminhamento. Procurou-se conhecer os critérios e suas respectivas racionalidades ideopolíticas pelas quais as escolas definem as situações de vulnerabilidade escolar e encaminham seus alunos para o atendimento junto à rede, neste estudo, representada pelos Núcleos de Atenção à saúde da criança e do adolescente, Nascas. Utilizou-se a triangulação de fontes para a produção de dados (pesquisa documental, entrevistas coletivas e configuração de perfis) e, como estratégia analítica, o cruzamento de dados qualitativos e quantitativos por meio da análise de conteúdo e de indicadores de desempenho escolar. O estudo abrangeu os oito Nascas distritais de Porto Alegre, por meio de entrevistas coletivas com seus técnicos. A análise de conteúdo dos encaminhamentos das escolas, bem como a elaboração dos perfis escolares, foi realizada em um Núcleo selecionado como recorte amostral. As múltiplas metamorfoses pelas quais a saúde e a educação vêm marcando e demarcando seus espaços e contribuições, no cenário das políticas públicas no Estado e no município, encontram nos instrumentos e fluxos de encaminhamento uma das expressões do modo tradicional de conceber e operar com as práticas em saúde na ótica da medicalização do social, neste contexto, o do fracasso escolar. As situações de vulnerabilidade escolar (dificuldades de aprendizagem e repetência) são traduzidas pelas escolas como produto das condições físicas, psicológicas ou sociais dos alunos e, por isso, motivadoras dos encaminhamentos para atendimento clínico. Esse traço cultural é analisado à luz da constituição da esfera pública brasileira, da institucionalização das políticas de educação e saúde, constituindo-se na particularidade estudada, pelas suas múltiplas expressões, na reatualização de concepções do paradigma higienista que predominou nas relações entre Estado e sociedade civil, na emergência da questão social. Entretanto, na atualidade, as manifestações desse clássico fenômeno são diferentes e complexas e se processam pelo deslocamento do controle social exercido pelo Estado sobre os costumes e comportamento e moral da população, pela via da saúde, para o controle do consumo de drogas, serviços e artefatos visando à “saúde longa e perfeita”, exercida pelo mercado. Na contemporaneidade, a medicalização da vida social é um fenômeno que invade os espaços públicos e privados, mediada por novas inflexões da indústria do consumismo, que captura para a lógica do mercado as necessidades de saúde da sociedade. Neste contexto, o fracasso escolar é um campo potencial de investimentos à medida que é concebido como uma patologia, passível de ser tratada e curada por meio de intervenções terapêuticas e medicamentosas. Conclui-se que as condições de vulnerabilidade escolar atuais, apesar de suas especificidades, espelham a “condição” de vulnerabilidade social a que a população brasileira está exposta, considerando tais configurações do sistema do capital e de sua globalização, o que demanda um amplo debate societário acerca de seus efeitos para o conjunto da população brasileira, no qual trabalhadores da saúde e da educação têm muito a contribuir. / Social policies for health and education represent fields of action and knowledge of public and strategic relevance, considering their effects in the quality of life of Brazilian population. As they are social rights, they convey political disputes and instances of direct intervention of public state power and society, interconnecting social needs, which are demanded by the population, and the ways of referring and affording them by the State. School and health programs are devices of direct execution of these policies, having availability to population as their main objective by means of their services. This thesis studies the inter-institutional relationship established by the School Health Program and schools of the city of Porto Alegre, configuring their demands for assistance and their referring fluxes. We tried to know the criteria and the respective ideological and political understandings by which schools define the situations of school vulnerability and the way they refer their students towards assistance in the public net, represented in this study by Nascas (Center of Attention to the Health of Teenagers and Children). We used triangulation of resources to produce data (document research, group interviews, and profile configuration) and, as an analytical strategy; we crossed quantitative and qualitative data by means of contents analysis and measurements of performance at school. This study comprehends eight district Nascas in Porto Alegre, using group interviews with their technicians. The analysis of referring contents of schools, as well as the elaboration of school profiles, was performed at a specific Nasca selected as a sample for this work. The multiple metamorphoses by which health and education have marked and defined their fields and contributions in the scenery of state and municipal public policies, have their fluxes of referring as a traditional way of conceiving and operating practices of health in the point of view of the medicalization of the social, which means school failure in this context. The cases of school vulnerability (failure and difficulties in learning) are conveyed by schools as a result of physical, psychological and social conditions of their students and, for this reason, motivate referring to clinical assistance. This cultural feature is analyzed by the constitution of Brazilian public context, institutionalization of education and health policies in the specificity studied, by their multiple expressions, updating conceptions of hygienist paradigm which prevailed in the relationship between the civil society and the State, in the emergence of the social issue. However, nowadays, the forms of this traditional phenomenon are different and complex and proceed by the displacement of the social control exerted by the State over the customs and moral behavior of the population to the control of drugs consumption, services and devices aimed at the “ perfect and long health “ exerted by the market. Contemporarily, the medicalization of social life is a phenomenon that invades public and private sceneries, mediated by new inflections of the industry of consumption which confine the health needs of society to market rules. In this context, social failure is a potential field for investments as long as it is conceived as a pathology which might be treated and healed by means of medicinal and therapeutic practices. We conclude that the current conditions of school vulnerability, in spite of their particularities, mirror the condition of social vulnerability to which the population of Brazil is exposed, in regard to the configurations of the capitalist system and its globalization, thus requiring an extensive society debate about its effects for the entire Brazilian population in which workers of the fields of health and education have much to contribute.