Thesis advisor: David Karp / The purpose of this study is to examine the way(s) that people define and perceive anxiety in light of the dominant discourses about mental illness that permeate America today. Both mental health fields, such as psychology, as well as the pharmaceutical industry have supplied the mental illness discourse that is popular today in the US. Definitions of and treatments for mental illnesses have expanded rapidly over the past several decades. The result is a mental illness discourse that allows almost anyone to be defined as mentally ill and therefore also a candidate for medication. Additionally, this dangerous discourse has been both created and embraced by the people who ordinary Americans look to as authorities on mental illness – doctors and drug companies. The research conducted in this study is intended to address two main questions: First, what are people’s ideas about anxiety? How do they define and identify it? People’s levels of awareness about the topic in general provide insight into the influence that dominant discourses have had (or not had) upon them. Second, do people’s ideas about anxiety mirror the dominant discourse that is presented by mental health fields and the pharmaceutical industry? If the language that people use and treatment options that people seek closely mirror the language and treatment options suggested in the dominant discourse, then mental health fields and the pharmaceutical industry are having a significant influence upon the ways Americans think about mental illness. / Thesis (BS) — Boston College, 2010. / Submitted to: Boston College. College of Arts and Sciences. / Discipline: Sociology Honors Program. / Discipline: Sociology.

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

Direct-to-Consumer advertisements allow pharmaceutical companies to advertise prescription drugs directly to consumers. Increasingly, marketing executives employed by pharmaceutical companies are shifting the focus of these advertisements from promoting the drug as a product, to promoting illness in general. Pharmaceutical companies defend this movement saying the advertisements have an educational function to "inform" consumers.

Background: The theory of framing suggests that the media have the ability to influence how the public thinks about issues (Nelson, Oxley & Clawson, 1997; Chong & Druckman, 2007), by influencing what definitions, causal attributions, moral evaluations, and treatment recommendation the public considers applicable to an issue (Entman, 1993; Tewksbury & Scheufele, 2009). The theory of framing has been supported in studies of media representations of a variety of social issues. With particular relevance to this thesis, framing studies have suggested that health news often portrays the essence of health issues as highly alarming, with few efficacious treatment or coping options (Chang, 2012). The social issue this thesis focuses on specifically is infertility. Study 1: In Study 1, a content analysis is utilized to examine how Canadian print news frames infertility. One-hundred and fifty-seven Canadian print news articles that contained the key word “infertility” in the year 2012 were analyzed. Two independent coders read the articles, and coded each article using a predetermined coding strategy (Chang, 2012) for if/how infertility was framed with respect to: prevalence; need for alarm; severity; vulnerability; need for alertness; means of coping; causes; and possible solutions. Just over one-half of the articles employed alarm frames (n=80), and the vast majority of these met the criteria for categorization as high alarm (96%). The most commonly cited cause of infertility was delayed childbearing (41% of articles) and the most frequently presented way to cope with infertility was in vitro fertilization (IVF; 46% of articles). Infertility was most often constructed as a women’s issue. Study 2: Study 2 build on Study 1 by examining the influence that high alarm framing strategies in the presentation of infertility have on news consumer reactions to, and knowledge of, infertility issues. One hundred and thirty-nine male and female undergraduate students were randomly assigned to read news articles focusing on infertility judged to employ either high alarm framing strategies (high alarm condition, n=65) or low alarm framing strategies (low alarm condition, n=66). Participants in each condition read the assigned news articles and subsequently completed a self-administered questionnaire. The questionnaire included measures of: fear of infertility, perceived severity of infertility, perceived vulnerability to infertility, worry about infertility, prevention efficacy, coping efficacy, and knowledge about infertility. The participants in the high alarm condition evidenced higher levels of perceived vulnerability to infertility (p = .04), and marginally higher levels of worry about infertility (p = .075) than those in the low alarm condition. In contrast, participants in the low alarm condition relayed higher levels of infertility related knowledge than those in the high alarm condition (p= .001). Discussion: Canadian print news portrays infertility as a serious, a prevalent, an alarming and predominantly a women’s disease, and presents IVF as the principal means of coping. This partial depiction of infertility may not be promoting informed reproductive decision-making. Print news portrayal of infertility using high alarm framing strategies may induce higher worry about infertility and heightened levels of perceived personal vulnerability to infertility, while neglecting to relay pertinent knowledge about infertility. Implications for the societal understanding of infertility and the potential repercussions for informed reproductive decision-making are discussed.

This study aimed to create a holistic understanding of the physician experience in relation to telemedicine. This study examined a Tele-NICU and a Tele-ER program at a large metropolitan pediatric specialty hospital with a Level IV NICU that provides telemedicine consults to 16 remote sites across Texas. Twenty-four semi-structured interviews were conducted with physicians and nurses at remote hospitals, physicians who provide consultations from the pediatric specialty hospital, and managers of the tele-specialty programs. These interviews were coded using the consolidated framework for implementation science to contextualize program strengths and weaknesses and reviewed to make recommendations for future program development. Remote site participants reported that the programs are useful when they are in need a second opinion and providing reassurance to patient's families. Barriers to program use include issues with the tele-carts, insurance acceptance, and hesitation to request a consult. Study findings demonstrate the need to treat each tele-specialty programs as independent to suit the differing needs of both remote sites and the consulting physicians. This study demonstrates the importance of understanding physician's perspectives, culture, and the role of hospital settings in telemedicine program acceptance and refutes telemedicine as a monolithic solution to limited healthcare access.

Orientador: Mário Sérgio Vasconcelos / Banca: Leonardo Lemos de Souza / Banca: Elizabeth Piemonte Constantino / Banca: Rosana Aparecida Albuquerque Bonadio / Banca: Solange Pereira Marques Rossato / Resumo: A medicalização é um processo ideológico que transforma problemas de ordem social em biológicos e tem sido legitimada pela Psicologia em vários momentos históricos, para ocultar desigualdades sociais, colocando sobre o indivíduo a causa e a responsabilidade por seu "fracasso". Atualmente se constata, na área educacional, um crescente número de crianças sendo medicadas com supostos transtornos de aprendizagem, evidenciando, assim, um período denominado de "Era dos Transtornos". Buscando desvelar esse fenômeno, esta pesquisa analisou criticamente a relação do processo de patologização e a apropriação do conhecimento psicológico pela medicina no projeto de modernização da sociedade brasileira, bem como a medicalização da educação a partir do resgate histórico da formação do psicólogo no Brasil. Mais especificamente, o objetivo desta pesquisa foi verificar, junto a cursos de graduação em Psicologia, como os alunos estão sendo instrumentalizados a se posicionarem diante da problemática da medicalização. Nessa perspectiva, este estudo questiona: Os cursos de graduação têm refletido sobre esta temática? Quais eram as vertentes de discussão sobre a medicalização e as dificuldades de aprendizagem? Que abordagens serviram de fundamentação? A fim de responder a estas questões, realizou-se um estudo de campo com professores de cursos de Formação em Psicologia de três universidades públicas do estado do Paraná. Os Planos de Ensino dessas universidades foram analisados e procedeu-se às... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Medicalization is an ideological process that transforms social problems into biological issues and has been legitimized by Psychology in several historical moments to hide social inequalities, placing on the individual the cause and the responsibility for its "failure". Currently, in the educational area, an increasing number of children are being medicated with supposed learning disorders, thus evidencing a period called the "Age of Disorders". Seeking to unveil this phenomenon, this research critically analyzed the relationship of the process of pathologization and the appropriation of psychological knowledge by medicine in the modernization project of Brazilian society, as well as the medicalization of education from the historical rescue of the psychologist's training in Brazil. More specifically, the objective of this research was to verify, together with undergraduate courses in Psychology, how students are being instrumented to position themselves in the face of the medicalization problem. From this perspective, this study asks: Do the undergraduate courses reflect on this subject? What were the areas of discussion about medicalization and learning difficulties? What approaches served as a basis? In order to answer these questions, a field study was conducted with teachers of Psychology faculties at three public universities in the state of Paraná. The Teaching Plans of these faculties were analyzed and the interviews with those teachers were carried out... (Complete abstract click electronic access below) / Doutor

This research examines the structure of the NICU (neonatal intensive care unit), a venue that juxtaposes a highly technological and medical setting against the care and nurturing of child by her parents. In this site, parents must construct and refine their definition of what it means to be a good parent in the context of the environment, medical professionals' expertise, and their child's hospitalization. At the same time, the health professionals on the unit are also impacted by their own experiences, preconceptions, and faith in medicine. Particularly relevant actors are the registered nurses, who care for babies but interact with parents; how nurses conceive of the parenting role influences the nature of this interaction, and therefore the experience of the parents in the unit. Yet nurses' definition of good parenting in the NICU often contradicts that of parents, and those who fail to meet the nurses' definition may find themselves labeled bad parents. Data for this research was collected in two urban NICUs. Mixed qualitative methods were used in the form of participant observation and in-depth interviews with both parents and staff members at both institutions, to the end of uncovering themes regarding commonalities of characterizations of good and bad parenting. Findings demonstrate that in constructing a definition of good parenting, parents medicalized themselves in the context of the NICU. Many incorporated medicalization into the parental role by accepting the notion that they could help to heal their baby, not just through care work but by actively taking on responsibilities that they felt could be beneficial. Parents' definitions of good parenting also included relying on the opinions of medical experts, which demonstrated a faith in the professionalization of medicine and the medicalization of childbirth and child care. Nurses' conceptions of what made up a good parent included deference. Many believed that parents needed to do what was best for the baby, defining this in part by stating that it meant listening to the experts, including themselves. Taking a Foucauldian approach to examine the position of nurses in the hospital, this fulfilled a need many nurses had to be respected for their skills and feel powerful on the unit. Additionally, nurses would label those whom they did not feel were meeting their parameters for being a good parent as bad parents, which often involved judging parents on the basis of their actions before or during their pregnancy. Parents were also judged based on how they acted in the unit. The bad parent label was applied both to parents who had confidence in their own abilities to parent while in the NICU, and also to mothers with a history of drug abuse. In accordance with labeling theory, once this label was affixed, it impacted the way that nurses and other staff treated parents and viewed all of their activities. The recent nature of this work reflects the impact of the newest technological innovations on the parental experience. This includes the increasingly sophisticated medical equipment in the NICU, what this has meant in terms of pushing the limits of viability, and the ability of parents to access information via the Internet. It also demonstrates the gap in parents' and nurses' ideas in the NICU, validating the place of sociology in discussions of family-centered care. / Sociology

Throughout the twentieth century, many behaviors previously considered criminal or immoral were instead defined as medical problems. This process is often referred to as the medicalization of deviance. Like many other behaviors once considered deviant, drug and alcohol abuse has been medicalizing, in a process that accelerated during the latter half of the twentieth century. Despite this movement along the path toward medicalization, drug use, and alcohol use to a lesser extent, are still also sanctioned and managed by the criminal justice system, resulting in a medical-legal-moral hybrid definition of these issues. Today we find instances where these two institutions overlap significantly. At the same time, their mutual involvement in defining and managing drug use is inconsistent. This research uses a qualitative research design to study how this medical-legal-moral hybrid definition of drug use and addiction is discussed and negotiated by various institutions that label and manage individuals who use drugs. I examined this issue by conducting interviews and observations in Philadelphia's Drug Treatment Court as well as in two outpatient drug treatment programs. Results indicate that individuals in both settings frame addiction as a "disease," although the definition is ambiguous and inconsistent. The court and the treatment programs use similar language and methods for assessing substance abuse and how to deal with it. Both also extend the definition of "addiction" to include aspects not directly related to the consumption of drugs or alcohol but to the "drug lifestyle" that includes selling drugs. Still, in neither location is a comprehensive, clear definition of "addiction" promoted and used consistently. This ambiguity results in an overlap of therapeutic and punitive methods to handle the individual's drug usage. In addition, both settings benefit from their interaction and cooperation in managing individuals with substance abuse problems, indicating that rather than moving toward a purely "medical" way of dealing with substance abuse, or placing the issue more firmly in the realm of the criminal justice system, the current mix of moral, criminal and medical methods of labeling and managing substance abuse problems may be more stagnant than the medicalization of deviance thesis suggests. / Sociology

Thesis advisor: Brian Gareau / Thesis advisor: Stephen Pfohl / This ethnographic study follows Greater Boston birth workers to understand the following questions: 1) What do area birth workers see as the problems within the maternity care system? 2) What role does knowledge, i.e. medical vs. alternative knowledge, play in their work? 3) What is their reason for doing this work? 4) How do they go about their work? In analyzing my ethnographic data, I used theory on discourse, power and knowledge (Foucault 1973; 1971; 1978; 1980), childbirth and authoritative knowledge (Davis-Floyd & Sargent 1997), the commodification of healthcare (Rylko-Bauer & Farmer 2002), and social movement theory, including work on communities of practice (Wenger 1998), reflexive consumption and citizen publicizers (DuPuis 2000) and consciousness-raising (Hooks 2000). Through this I find that Greater Boston birth workers find fault with the singularity of medical discourse surrounding birth and with the fact that the commodification of healthcare has resulted in lower quality care for marginalized populations, primarily people of color and low socioeconomic status (SES) individuals. Furthermore, Greater Boston birth workers aim to advocate for their clients through the unique discourse about birth which their community has formed. By employing narratives counter to medicalized birth and sharing alternative, experiential knowledge, birth workers allow women to be conscious of the ways the medical maternity system does them a disservice. / Thesis (BA) — Boston College, 2019. / Submitted to: Boston College. College of Arts and Sciences. / Discipline: Scholar of the College. / Discipline: Sociology.

This dissertation explores the knowledge systems that doulas use to legitimate their work to the medical community, and to clients. "Doula" comes from a Greek word that means "a woman who serves." In contemporary English, doulas are women who provide other women with support during labor and childbirth. Although research shows that doula support can have positive physiological and psychological effects, doulas' lower social status in the birth fields constricts their reach to those who know about and can hire them privately. In the United States, obstetricians have authoritative knowledge over birth, and all others fall beneath them in the hierarchy of medicine. Doulas serve as a case for exploring the importance of certification and science, versus alternative forms of knowledge for legitimating their expertise within the field of childbirth. This research uses a mixed methods approach to explore the roles that authoritative versus alternative sources of knowledge play in doulas' attitudes and approaches to childbirth. Data come from the Maternity Support Survey, an original, cross-national survey of nurses, doulas, and childbirth educators in the United States and Canada. I also rely on content analysis of five large doula organizations' websites, and interviews with twenty-five doulas, and twenty-five mothers who hired or considered hiring a doula to support them during labor and delivery. This mixed methods research looks at how doulas can legitimate their role in order to better serve women.Results suggest that both authoritative knowledge systems (such as certification) and alternative knowledge systems (such as feminism) influence doulas' approach to legitimating their work. Scientific evidence serves as both an authoritative and alternative source of knowledge, depending on the context. This research has important implications for the future of doula support; while alternative knowledge systems allow doulas to empower women and challenge the dominance of medicalized birth, authoritative knowledge systems allow doulas greater access to the women who need them most. In order to reach a greater population of women, doulas need to find a balance between challenging authoritative medicine and working within it to best serve women.