SOCIAL PATHOLOGY AT IMPASSE:
THE DILEMMA OF TREATMENT PROGRAMS
BY CAL EASTERLING, PH.D.
Associate Professor of Sociology
Oral Roberts University
(COPYRIGHT 1998)
THE WILD GOOSE CHASE
The medicalization of deviance (Foucault, 1963) refers to the
identification as diseases or illnesses patterns of behavior that were
previously considered in moral terms. Herbert Spencer (1898) viewed
society as analogous to a living organism. A problem or "disease" in
one part of the organism affects the entire organism. Early
sociologists built on this idea and arrived at the conclusion that
deviant behavior could be thought of as "social disease"
(Durkheim, 1925) and "social pathology" (Mills, 1943; Lemert, 1951).
"Pathology" is a medical term that indicates the
interpretation and diagnosis of disease and the changes caused by
disease. The early social pathologists were concerned with crime,
mental illness, drug abuse, and suicide. Today this list has been
expanded to include alcoholism, stress, smoking, child abuse,
obsessive-compulsive tendencies, pedophilia, spouse beating, spiritual
abuse, over-eating, under-eating, marital difficulty, compulsive
gambling, divorce adjustment, compulsive shopping, bereavement,
trichotillomania, rape, Vietnam veterans, depression, post-partum
depression, physical unattractiveness, anxiety and panic-attacks,
sexual addictions, cross-dressing, co-dependency, mood-swings, and
many other behaviors. There is a tendency to treat such "ailments" in
a hospital or clinical setting. Undoubtedly, the hospitals and clinics
benefit monetarily from treatment programs, and some individuals and
families are aided by the treatment. To the extent that they
ameliorate suffering and facilitate economic growth, treatment
programs may be regarded as functional for society. Overall and in the
long-term, however, the trend toward the medicalization of deviance
can be thought of as dysfunctional (Merton, 1968) in several ways.
FIDDLING WHILE ROME BURNS
Whatever Became of Sin?
The medicalization of deviance removes responsibility from the
individual. According to Talcott Parsons' (1953; 1975) "sick role"
concept, sick people are not responsible for their conditions. Being
sick is unpleasant and becoming sick is not a matter of moral choice.
People are "stricken" by sickness through no fault of their own. Those
who become sick, therefore, are not to be blamed or punished for their
maladies.
Popular entertainer Flip Wilson performed a celebrated comedy
routine in which he would use as his excuse for outlandish stunts,
"The devil made me do it!" It rang true to his audiences because of
the hesitancy of most of us to accept the blame for our own actions.
Psychiatrist Karl Menninger (1973) wrote a book entitled
Whatever Became of Sin? in which he decries the all-too-common cop-out
"It's not my fault." He insists that as adults, each of us is
responsible for the deeds done in her own body. Blaming behavioral
problems on a genetic "predisposition" or chemical imbalance or on
one's parents, employer, etc., though at times there may be some basis
for such claims, implies a biological or psychological determinism
that is not entirely satisfactory for most social scientists.
The Social Nature of "Dysfunctional Behaviors"
The medicalization of deviance also removes responsibility
from the society which continues the perpetual production of
perpetrators of deviance. Even though a particular treatment program
should actually help an individual or family, it will not have changed
the social system which originally produced the problem. Medicalized
deviance may be an individual's problem in a narrow context, but it is
at root a social problem. Jeffrey Reiman (1979) has stated that the
failure to focus on the social responsibility for deviance literally
acquits the existing social system (hence, its oligarchic or
Plutocratic leadership) of any charge of injustice. Let us use the
problem of alcoholism to illustrate this principle.
Society allows the advertising of alcoholic products. There
have been wars that were fought but never declared, such as the Korean
and Vietnam "conflicts." There have been wars that were declared but
never fought, like the War on Poverty and the War on Drugs. How can we
say that the War on Drugs has not been fought? Isn't there a Drug Czar
appointed by the President and a huge Drug Enforcement Agency? Yes,
but the War on Drugs does not aim at alcohol, which is the drug of
choice in the United States, including the White House, Calvin
Coolidge having been the only United States president in this century
who was a teetotaler.
The advertising of smoke tobacco products on television and
radio was banned in the United States in 1971. There was a decrease in
the number of new smokers in 1972 and the decline has continued every
year since. Today, smoking (with the recent exception of cigar smoking)
has virtually become socially unacceptable and legislative statutes as
well as voluntary efforts are creating smoke-free environments for
work, dining, study, and recreation. Law-suits against the large
tobacco companies are driving them to diversify their investment of
capital to non-tobacco industries or to market their tobacco products
in the Third World. John Macionis (1992) has said, "The American
tobacco industry is not breathing as easily as it once did."
Why have we not done the same with alcohol? Tobacco related
deaths number over 300,000 per year in the United States, due to a
variety of diseases, including heart disease, cancer of the mouth,
throat, and lungs, bronchitis, and emphysema. This is indeed
reprehensible, but far more damage is done to our society by alcohol
abuse, in terms of automobile accidents, broken homes and careers,
child abuse, and violent criminal acts, than tobacco or any other drug--
including marijuana, heroin, cocaine, and speed. Eighty percent of all
fire deaths, 65 percent of drownings, and 70 percent of fatal falls
are related to alcohol use (Feagin & Feagin, 1990). In the workplace,
alcoholism is responsible for absenteeism, excessive medical bills,
and poor job performance, making it the most costly type of substance
addiction.
The giants of the alcohol industry, such as Anheuser-Busch,
Coors, and Philip-Morris (Miller Brewing), spend billions of dollars
on advertising in order to convince the public that alcohol drinking
is respectable and socially desirable (Feagin & Feagin, 1990). Much
of the marketing has been directed at young people, the obvious
purpose being to secure a new generation of users. These corporations,
in their profit-oriented activities, have been responsible for getting
many Americans addicted to dangerous substances.
A simple ban on alcohol advertisements on television and radio
would benefit our society far into the next century. This could result
in a true War on Drugs. Formidable opposition to such a proposal could
be expected from the beer and wine producers and distributors, the
advertising agencies with alcohol clients, and the owners of
television and radio networks and stations. Past attempts at
prohibition have failed. The right to sell and consume alcoholic
products is not in question; but is it really necessary to promote and
advocate alcohol consumption? Similar reports could be related about
numerous additional medicalized deviancies, amply illustrating the
social nature of so-called dysfunctional behaviors.
Bonum Ex Nocentibus
The medicalization of deviance ignores certain economic
deterministic truths of the social inequality inherent in a market-
driven economic system. In the United States, 80 percent of the wealth
(money and goods--including real estate and stock ownership) is held
by the top 1/5 of the population, whereas the bottom 1/5 control no
wealth at all (United States Bureau of the Census, 1990).
One is reminded of Adam Smith's (1776/1937) great paradox of
bonum ex nocentibus ("a good product from an evil source"). He claimed
that "from individual self-interest and the personal pursuit of profit
comes the greatest good for the greatest number of people." By this
Smith meant that in the process of self-interested entrepreneurship,
many jobs are generated and essential or desirable commodities are
made accessible to the public through the production, distribution,
and consumption of goods and services. The profits themselves are
subsequently diffused throughout the economy by means of spending and
further investment. The paradox stems from the nature of "self-
interest" or selfishness, the heart of which is avarice--greed--the
love of money, the root of all evil (St. Paul, 65).
One can argue that many social problems identified as
individual deviations from societal norms are actually outgrowths of
the pursuit of profits, legal or illegal, ethical or unethical.
Consider the drug trade, the liquor and liquor service industries, the
pornography industry, the tobacco companies, the various weapons
manufacturers, the credit card companies, and the casino industry. Do
the captains of these enterprises really care at all about the
well-being of individuals and families, or only about their own
continued profits at others' expense?
The Placebos of False Consciousness
The medicalization of deviance contributes to what Marx called
"false consciousness" (1867/1983) by hiding from view the "class
consciousness" that would reveal the underlying root causes (radix)
(Feagin & Feagin, 1990) of deviance-related social problems. The
opiates of the masses (sport, television, alcohol, religion, etc.)
detract the public's attention from the exploitation and alienation
that lie at the heart of society's problems.
The myriads of (predominately "for profit") treatment programs
produce the convincing illusion that something worthwhile is being
done about society's "behavioral problems." The use of the word
"treatment" is particularly deceptively comforting because it gives
the impression that the problem is being "treated;" i.e., alleviated,
assuaged, "taken care of," and by professionals, no less. "Oh well, we
have a treatment program for that, so let's worry about this other
problem."
One person's efforts at recycling may not save a forest, but
if one tree can be saved the endeavor will have been worthwhile. The
essence of the problem, however, does not lie in the lack of recycling
effort, but in the destruction of forests. If one compulsive gambler
is effectively assisted by a treatment program, it will have served a
constructive purpose, but it will not have prevented the creation of
many more compulsive gamblers. Treatment programs, unfortunately, do
not prevent the creation of millions more child abusers, pedophiles,
spouse beaters, over-eaters, under-eaters, drug addicts, alcoholics,
rapists, and suicidal individuals, ad infinitum.
Out of the Frying Pan...
The treatment programs resulting from the medicalization of
deviance turn the individuals "treated" back into the same social
milieu in which the problem was incubated in the first place (Glassner
& Freedman, 1979). Clinical sociologists and sociological practitioners
point out that the "treated" individual will likely once again be
subjected to the same underachieving kids, nagging spouse, exploiting
boss, stacks of unpaid bills, and negative media reporting. In the
case of alcohol, she will view the same commercials and advertisements
which strongly advocate the use of the substance. She may still
associate with the same friends and drinking-buddies she had before
treatment, and her society will still baptize the use of the substance
as a proper means of the ceremonial observance of weddings, wakes,
anniversaries, and other celebrations and holidays.
The individual will likely have already been labeled as
deviant and entered into secondary deviance through a paradigm shift
in her self-concept. The struggle to become unstigmatized after having
spent several years in a deviant career can be a dreadfully perplexing
experience. The few widely-heralded success stories applauded in the
media do not adequately reflect the reality of repeat offenses after
"treatment" and the extent of reversion to deviant status. The
"success rates" of certain treatment programs (such as those dealing
with pedophiles) are near zero percent.
Monetary and Social Costs of the Micro-level Focus
In addition to draining the individual's and the family's
resources, the expensive, temporary, isolated treatment of individuals
inflicts a severe non-cost-effective depletion on societal income.
Individual-oriented treatment programs absorb resources that could be
used for the transformation of society toward a more just and
equitable model. Such a transformation would involve minimizing racism,
sexism, ageism, economic inequality, and moral/spiritual depravity.
The social costs of not implementing a deeply-rooted social
overhaul will be tremendous. Entire future generations will remain
chained to addictions, abuses, exploitation, and insufficient social
resources to maintain a state of relative health--physical, mental,
and emotional well-being. The continued focus on micro-level solutions
for society-wide problems will reinforce the abiding endurance of
these problems throughout perpetuity.
The Vested Interest Leviathan
The medicalization of deviance creates a vested interest
(Veblen, 1919) industry of politically and economically influential
professionals whose very training and careers depend upon the
treatment of individuals. The treatment programs which arise to meet
the "challenge" are usually associated with clinics and hospitals that
are hungry for expansion of services to enhance market share and
therefore profits from individuals and insurance companies. Not only
are the perpetrators and victims said to require treatment, but also
the families of both perpetrators and victims. This tendency is
economically beneficial to the hospitals and clinics, their
stockholders, therapists/physicians, and employees, their advertising
agencies, the advertising media, and the pharmaceutical companies with
chemical "solutions" for virtually every problem.
CONCLUSION
The medicalization of deviance has constructed a system of
individualized micro-level treatment programs that can be beneficial
on a limited basis for a few individuals and their families. We should
not be satisfied with such a social arrangement, however, because it
tends to treat only the symptoms but does not change the society of
which they are but indicative emanations. Like the application of
topical salve on a cancer the roots of which are in the bone marrow,
the blood, or an internal organ, the process is an expensive exercise
in futility.
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