Of Others Inside: Insanity, Addiction And Belonging in America

Foreword

Foreword Social science, and specifically sociological, approaches to health and illness have been typically bifurcated around a dichotomy between what, for convenience, we might call naturalism and social constructionism .Naturalisticexplanationsseekphysicalcausesofhealthand illness on the assumption that disease can be effectively controlled or eliminated by targeted medical intervention. This approach historically involved treating the human body as a machine that could be manipulatedbymedicalsciencewithoutthedistractionsofsuchdubiousentities as “mind’’ or “subjectivity.’’ The spectacular treatment of the infectious diseases of childhood in the late nineteenth and early twentieth century provides the ideal model of medical science and its therapeutic potency. Of course, critics of this vision of medical history argue that these treatments were successful only after the social and physical environment had been improved by the introduction of sewerage, clean water, and an adequate food supply. Perhaps more importantly in the present context, while the physical etiology for example of measles has been successfully identified, there is far less scientific consensus as to the physical “substance ’’ that produces alcohol addiction or mental illness. Similarly, the quest to discover genes that explain specific forms of social deviance is like a fable from Don Quixote in the sense that deviancy, because it is paradoxically a product of law or moral convention, does not lend itself to such explanations. The classic sociological argument is that the search for a genetic explanation of deviancy involves a category mistake . As Emile Durkheim argued, social facts can be explained only by social facts. Is homosexuality a genetic disorder, a socially constructed category, or a lifestyle choice? Is there a gene to explain the prevalence of divorce in modern society? Perhaps, but first we need to find the gene that will explain the prevalence of matrimony. We tend to assume that matrimony needs no explanation simply because it is a “normal’’ relationship between men and women that has the blessing of the Law. We tend to look for naturalistic explanations in the social sciences only when phenomena appear to be untoward. xi xii Foreword The naturalistic research strategy looks particularly unpromising if our effort is to explain the link between mental disability and patterns of social exclusion such as homelessness. At least some aspects of homelessness will be a function of macrosocial and economic changes— including interest rates, property prices, the rental market, availability, local governmental policies, and so forth. The complex causal processes behind the housing market do not allow for simple biological explanations of aggregate homelessness. Moreover at the individual level, the social reality of alcoholism is profoundly shaped by local circumstances . The consumption of whisky among middle-class Scots may be addictive from some perspectives, but we know that middle-class resources (income, education, and connections) typically act as a buffer against negative labeling, permitting them to manage such dispositions or preferences without coming to the attention of the authorities. Homeless men consuming alcohol in public spaces in Britain are by contrast very likely to come to the attention of the police. In the everyday world, my consumption preferences may very well constitute someone else’s addiction. These arguments are well known, and possibly taken for granted by socialscientists.Inordertoavoidthesepitfallsofnaı̈venaturalism,social constructionist sociologists have contested clinical labels, arguing, for example from the standpoint of symbolic interactionism, that pathology is in the eye of the beholder. Alcoholism exists if a professional person can deploy expert knowledge to secure the social efficacy of the label. I am mad if a label of insanity can be successfully attached to me or, in the famous words of W. I. Thomas, definitions are real if they are real in their consequences. Social constructionist critics of the naturalist position have drawn attention to the social processes by which “troubles’’in some very broad sense get translated into recognizable medical “conditions ’’that professional groups can diagnose and if necessary treat. Constructionist epistemologies have many and diverse origins—including the pragmatism of Richard Rorty and the poststructuralism of Michel Foucault.Theseapproachesatoneleveldemonstratethat,insofarasconditions have a history, they can be shown to be context-dependent and hence determined by a welter of social and cultural variables. Foucault’s classical accounts of the history of psychiatry, penology, and criminology in such influential studies as Discipline and Punish or Madness and Civilization have had an important general impact on the study of professional groups and institutions and their systems of knowledge. In his powerful and commanding study of mental illness, Foucault explored [3.139.72.78] Project MUSE (2024-04-19 21:44 GMT...