Press' "Social Constructionism and Medicalization"

Press, Nancy (2006). “Social Construction and Medicalization” in Parens, Eric, Chapman, Audrey R, and Press, Nancy (eds.) Wrestling with Behavioral Genetics. Baltimore: Johns Hopkins University Press, 131-49.

Press argues that behavioral genetics depends on traits, concepts, and phenotypes that may not be the product of nature but socially constructed and therefore inconstant phenomena. This does not allow for the construct validity needed for natural inquiry and could lead the field astray with negative social consequences. Social constructionism is the idea that the traits under question have a social or environmental basis. Medicalization helps construct and reify the behaviors under which behavior geneticists engage. It can also refer to the increasing number of aspects of life that are being brought under the purview of medicine thereby making medicine more of a social force in social constructionism. Geneticization describes the extension of medicalization to the genetic realm. She attempts to get to the heart if universal versus localized traits and it’s link to genetic research. Do traits have to be universal to have a valid genetic component or is this more of the “gloomy prospect” applied to group? Her claim that it is possible to undertake a biographical investigation of a social construct speaks to the Husserlean idea of presuppositionlessness but that is also problematic. Can behavior ever be reduced away from the micro or macrocosm of the environment? My thoughts are that it might be possible in some cases. She may be onto something concerning universals but what about reexamining a “universal” within a cultural context? That would address her concern that culture dictates what we research but it does raise the issues of “What is believed to be true about behavior affects the very behavior which it purports to explain”. (Eisenberg, 1988, 145)

Press speaks to the way science should work against a holistic view that local interactions lend support. Ask Jim about the trend to be interdisciplinary with academic research. Would this not speak to a more holistic view of causation? The problem is that we cannot extract ourselves from within the social construct we are living and this is a difficulty with the scientific method we employ, the conclusions we make, and the very questions, as Press points out, we ask about human behavior. We have to remember to take a look at the possible difficulties with the DSM-IV and its susceptibility to social constructionism. It seems that Press thinks that psychiatry is more grounded in physicalism than psychology but the distinction and difficulties will be important when we start drawing the line based on APA criteria. We will also have to reference the idea of health as a status symbol in addition to normative language. I agree that medicalization and social constructionism surrounding traits in question may lead researchers astray but the question is how much is this a factor or does it depend on the trait in question as we seems to be heading for our project. I more strongly agree that the conclusions of genetic study have a impact on perception of behavior in society and that we are working along a continuum where we draw the line viz. “no bright line” is drawn”.

The last part of the essay speak to research with low rates of probability of success because of the aforementioned difficulties but what if the genetics drove the cultural norm in the first place. The debate for the evolutionary basis of altruism continues and it is here that we may or may not be able to tease apart nature versus nurture. She references Turkheimer and her slightly more positive take on the gloomy hypothesis. Last thought: she makes the distinction between smoking behavior and lung cancer as a focus for research as an example of medicalization but didn’t the research on the disease of lung cancer lead to a social construct that smoking is harmful and undesirable thereby pointing a reciprocal relationship between physical inquiry and social constructs? Hasn’t that been a good thing that we socially frown on smoking than we did 20 years ago or is that just my own perspective on the matter due to my own relationship to and within my society?