The Trend toward the Medicalization of Society
The medicalization of domestic violence is part of a more generalized trend toward the medicalization of society. A definition of the term ‘‘medicalization’’ may be in order at the outset: The term suggests that the field of medicine is used as a foundation for providing a conceptual framework in interpreting whatever phenomena are in question. The reason for this trend toward the medicalization of society has to do with the fact that medicine has come to be viewed as the pinnacle of science; that is, the epistemological assumptions that guide the construction of medical knowledge are often perceived by those inside and outside the academy as having more validity than those epistemological assumptions that inform the so-called social sciences.
The field of medicine has shrouded itself under the value-neutral veil of positivism despite the fact that there is a considerable body of evidence that may call into question the notion of objectivity with regard to the social construction of medical knowledge. Nevertheless, the general public seems more than willing to place the whole of medicine on a pedestal and willingly accepts a medicalized view of all manner of phenomena. Examples of the trend toward the medicalization of society abound. Witness the medicalization of pregnancy, sexual function, sport, and old age, just to cite a few examples.
Perhaps one of the most invasive areas within which the trend toward medicalization can be seen is that of deviance or crime. Increasingly, in Western societies, those behaviors judged to be problematic are being explained as resulting from some sort of medical problem or disorder. In short, the jurisdiction of the medical field has been expanded to cover things that are not medical in nature. Historically one can see the trend initiate perhaps with Lombroso’s theory of atavism, the mythical disease that the nineteenth-century Italian physician professed afflicted criminals. Atavism was diagnosed on the basis of the presence of various stigmata, the signs of atavism. Such symptoms included a protruding chin, pinched nasal nerves, ears set too far from the head, and hair growing in unusual places, among other symptoms. Today, atavism is regarded as one of the many mythical diseases that litter the history of medicine. One may also easily cite the early criminologists who practiced phrenology as evidence of an early trend toward medicalizing crime and deviance. Phrenologists studied the shape of the skull in an attempt to determine predispositions toward criminality in the individual. Bumps or ‘‘abnormalities’’ in certain places on the skull may have meant that the individual had a higher probability to engage in certain crimes. Today, of course, phrenology is a so-called dead science, once again pointing to the very social construction of knowledge that belies much of empirical science.
As the medicalization of deviance and crime began to evolve, it wasn’t long before the expanding field of the study of mental illness would be employed as a ready-made rational system for explaining criminal behavior. In short order, sociobiologists, psychologists, psychiatrists, and the like began to reify all manner of crime as illness or disease. Consider the case of kleptomania, the stealing disease, which, argued here, has been socially constructed. In the wake of industrialization women entered into public life en masse as never before to take up the new pastime of shopping. The newly emerging marketplace created a new opportunity with regard to crime, namely, shoplifting. The shoplifting perpetrated by working-class women could easily be rationalized in that these women were tantalized by all the temptations of conspicuous consumption and stole either out of need or to acquire that which they wanted but could not afford given their class position. Simply put, working-class women who stole were easily tagged as thieves. However, the problem was that not only were working-class women involved in shoplifting but so were their middle-class and upper-middle-class counterparts. Given the social conventions of the day, it was unacceptable to call upper-middle-class women thieves, and so a disease was created for them, namely, kleptomania. What could be made of these curious women who stole that which they could well afford to purchase? Many writers have suggested that such phenomena may have been explained as a form of rebellion against upper-middle-class domesticity, that is, wealthy women acting out.
More recently, despite the somewhat torrid history with respect to the medicalization of deviance and crime, in many cases—some, in fact, bordering on the absurd—society seems fully willing to refer to all serial killers as psychopaths, problem drinkers as alcoholics, and hyperactive children as sufferers from attention deficit disorder. Such behaviors range from the deviant to the criminal and are obviously problematic for the individuals and the societies in which they live, but the extent to which they derive from illness or disease is ambiguous at best. More to the point of this research paper are the questions of the extent to which domestic violence is being medicalized and the consequences of such a conceptualization.
How Is Domestic Violence Medicalized?
One of the main ways in which one can bear witness to the medicalization of domestic violence is through examining the language that is often employed in the institutions that are most likely to have some dominion over either the victim or the perpetrator of such violence. It is in this instance that one becomes engaged in the deconstruction of a medical discourse that characterizes health care institutions and increasingly more and more the institutions associated with the criminal justice systems.
Frequently, the first responders to instances of domestic violence are either hospitals or law enforcement. Victims of domestic violence are often encouraged to seek medical attention for the injuries they sustain at the hands of their perpetrators. But whether they enter into the health care system of their own volition or at the direction of law enforcement or perhaps, on rare occasions, are taken to the hospital by their aggressor, these individuals’ experiences are all informed by the medical discourse that engulfs them. From the outset these victims, who are predominantly women, are transformed into ‘‘patients,’’ who are administered to by doctors and nurses, and soon enough the language of diagnosis, treatment, and medicine eventually extends to frame even the ‘‘disease’’ from which they suffer.
Both Wilkerson (1998) and Davis (1988) have written about the medicalization of domestic violence, suggesting that the epistemological assumptions employed in medicine, in conjunction with the language of medicine, may obscure the nature of such violence and in the worst cases serve to amplify the suffering of those who have been victimized. Wilkerson (1998) reflects on Foucault’s The Birth of the Clinic (1975) to highlight the somewhat precarious claims to moral authority that inform medical discourse. She writes that the work ‘‘clarifies the relationship between the epistemology of medicine and its moral authority, tracing the processes by which the medicalization of society began to remap the moral domain from the soul onto the body’’ (Wilkerson 1998: 126). Such moral authority might also be seen as gendered inasmuch as science in general, and medicine in particular, has historically maintained an androcentric bias (Harding 1986).
Unfortunately the structure of patriarchal gender stratification that may be seen as informing domestic violence is the same structure that largely predominates in health care institutions. Though well meaning, health care professionals may be sabotaged in their efforts to extend aid to victims by the medical frame employed in the diagnostic process. Gelles and Straus, in their compelling Intimate Violence (1988), suggest that nearly all interested parties concur that the ‘‘medical system’’ has the greatest responsibility with respect to identifying, treating, and preventing domestic violence. Interestingly enough, given the discussion of the androcentric bias in medicine, the authors suggest that the medical system does a better job in the area of child abuse relative to wife abuse. ‘‘Wife abuse has not assumed the same place on the medical system’s treatment and policy agenda that is held by child abuse and neglect. For the most part, doctors and psychiatrists are seen as even less helpful to battered women than are the police’’ (Gelles and Straus 1988: 178). Though in their own family violence survey Gelles and Straus (1988) found that the majority of women were satisfied with the medical treatment administered to them by health care professionals, the authors did cite the work of Stark, Flitcraft, and Frazier (1983), who found otherwise.
These three authors suggest that the medical system may contribute to the problem more than to the solution. The authors suggest that the patriarchal gaze of the medical practitioner may cast doubt on the mental health of the victim. The researchers found that women who were victims of domestic violence were often regarded as psychotic or malingerers, and like their precursors who suffered from hysteria, they would be best treated with sedatives or ‘‘nerve pills’’ and sent home. Taking a cue from labeling theory, the authors suggest that given this type of societal reaction, such battered women may have legitimate reason to question their own mental health and make an internal attribution about the violence they suffered.
Davis (1988) echoes the sentiment that casts suspicion on this androcentric bias in medicine that may complicate the understanding of domestic violence. Her research highlights a paternalistic character in the practice of medicine wherein ‘‘general practitioners [are] making moral judgments about women’s roles as wives and mothers, psychologizing women’s problems, not taking their complaints seriously, [advocating] massive prescription of tranquilizers, [and] usurpation of women’s control over their reproduction’’ (Davis 1988: 22).
Most recently Kurz (2005) has found evidence of some resistance toward the medicalization of battering in at least some quarters of the medical establishment. Kurz (2005) studied emergency department staff at four hospitals. The author notes that at least one of those hospitals was engaged in efforts to encourage staff to view domestic violence specifically within a medical framework. Kurz (2005) made the following observation with respect to a physician’s assistant working in the hospital so inclined to medicalize domestic violence: ‘‘She believes the battering aspect of a case is a legitimate medical concern and compatible with her own role. She refers to battering as a ‘syndrome’ with distinct medical symptoms, and urges others to ‘diagnose’ the condition’’ (Kurz 2005: 215).
Despite the general trend toward medicalizing behavior and the specific efforts of hospital staff in at least one instance to have emergency department staff see battering as a medical problem, Kurz (2005) found widespread resistance amongst the first responders. Riding against the tide of many feminist writers, Kurz suggests that this resistance toward the medicalization of battering is problematic in that it serves to render many victims, particularly those who are judged by staff as being morally undeserving, invisible. ‘‘The second and third factors affecting staff’s lack of response— that they feel there is little they can do, and that they don’t see this as a legitimate medical problem— mean that staff feel that responding to battered women detracts from their ‘real’ work’’ (Kurz 2005: 217). Surprisingly, there appears to be some residual medicalization going on in the case of these deemed undeserving victims, that is, the author suggests, as has been discussed previously, that women who are labeled with ‘‘stigmatizing traits’’ are often not treated for battering per se, but rather are seen as suffering from drug abuse, alcoholism, or depression.
Rethinking Medicalization of Domestic Violence
While it is imperative to understand the intersection of the biological system and the social system with respect to making sense of and dealing with issues related to domestic violence, there is a present danger in reifying crime as disease or illness. Like many so-called conditions that have been appropriated by medicine of late, domestic violence may produce injuries that require medical attention, and writers such as Kurz (2005), Davis (1988), and Wilkerson (1998) have discussed at length the extent to which the ensuing medicalization process contributes to or detracts from the state of the domestic violence victim. Some have argued that medicalizing the problem in turn individualizes the problem, thereby isolating an individual in dire need of social support. ‘‘Pathologization also serves to obscure the group identity of women who are battered, perpetuating the sense that their suffering is an isolated personal problem, due to bad luck or their own inadequacy—rather than a common manifestation of relationships between men and women in this society’’ (Wilkerson 1998: 129).
Whatever the good intentions of the medical establishment in treating victims of domestic violence with respect to a pathological perspective, it is clear that there is considerable debate regarding the efficacy of medicalizing battering. Likewise it is important to raise serious questions regarding the medicalization of the abusers as well. Pathologizing perpetrators of domestic violence serves to obscure a social structure characterized by a patriarchal system of gender stratification that has historically afforded some tolerance for many forms of violence, and certainly that done to women in domestic life. Contemporary Western culture is filled with contradictions regarding violence and sex, which often become entangled in the popular culture. Simply the hypersexualization of women may objectify them sufficiently so that they are in a more vulnerable position with respect to the probability of being victimized by violence.
The fact that domestic violence was traditionally shrouded in the normalcy of family makes an understanding of the phenomenon limited to cases that have been observed. Nonetheless, the power differentials that define gender relations in the family are important to examine in an attempt to understand the problematic behavior. Although the social construction of gender is not static, and significant changes in gender relations have been observed in the past seventy-five years, power differentials in familial relations remain a constant. Couples’ relationships may be informed by power differentials with respect to physical strength, sex, and economic position. Some religious ideologies may even validate the naturalness of a hierarchy with respect to gender relations. However, such structural and cultural factors in explaining domestic violence are undermined when theorists, practitioners, and criminologists employ a medical discourse with references to ‘‘battered syndrome’’ and discuss the ‘‘epidemiology of domestic violence.’’ While the notion of treating domestic violence as a disease may be appealing to some in that invoking treatment suggests the possibility of a ‘‘cure,’’ we are by no means in a better position to seek social changes, indeed structural and cultural changes, that may serve to reorganize gender relations in such a fashion as to reduce the probability that women will be subject to domestic violence in their lifetimes.
- Davis, Kathy. ‘‘Paternalism under the Microscope.’’ In Gender and Discourse: The Power of Talk, edited by Alexandra Todd and Sue Fisher. Norwood, NJ: Ablex, 1988.
- Foucault, Michel. The Birth of the Clinic, translated by A. M. Sheridan Smith. New York: Vintage Books, 1975.
- Gelles, Richard, and Murray Straus. Intimate Violence. New York: Simon & Shuster, 1988.
- Harding, Sandra. The Science Question in Feminism. Ithaca, NY: Cornell University Press, 1986.
- Kurz, Demie. ‘‘Emergency Department Responses to Battered Women: Resistance to Medicalization.’’ In Violence against Women, edited by Claire M. Renzetti and Raquel Kennedy Bergen. New York: Rowan & Littlefield Publishers, 2005.
- Stark, Evan, Ann Flitcraft, and William Frazier. ‘‘Medicine and Patriarchal Violence: The Social Construction of a Private Event.’’ In Women and Health: The Politics of Sex in Medicine, edited by Elizabeth Fee. Farmingdale, NY: Baywood, 1983.
- Wilkerson, Abby L. ‘‘Her Body Her Own Worst Enemy: The Medicalization of Violence against Women.’’ In Violence against Women: Philosophical Perspectives, edited by Stanley G. French, Wanda Teays, and Laura M. Purdy. Ithaca, NY: Cornell University Press, 1998.