GENDERING THE MEDICALIZATION THESIS

Sedated masculinity: the use of anaesthesia during vasectomy in Israel

Vasectomy is considered a permanent form of contraception for men that can help reduce reproductive inequality. Its underutilisation in the context of the threats it may pose to perceptions of traditional masculinity has been closely investigated, but the lived experience of the procedure itself has been largely overlooked. This paper examines the experience of having a vasectomy in Israel, focusing on the recommended form of anaesthesia. Drawing on 15 semi-structured interviews with Israeli men who have experienced vasectomy, we found that the choice of anaesthesia has a significant impact on the meaning and experience of vasectomy. Unlike the widespread use of local anaesthesia during vasectomy in other countries, vasectomy in Israel is performed almost exclusively under twilight sedation administered intravenously. Based on our findings, we argue that framing vasectomy as an operation that requires sedation is related to views of masculinity and reproduction. Our data suggest that vasectomy in Israel is constituted as a potentially traumatic event, and anaesthesia is employed to protect patients from feelings of embarrassment and discomfort. We conclude that the prevailing method of sedation perpetuates the silencing and marginalisation of vasectomy as a contraceptive method, and consequently, its very limited accessibility in Israel.

Cohort Change in the Prevalence of ADHD Among U.S. Adults: Evidence of a Gender-Specific Historical Period Effect

Objective: To document inter- and intra-cohort changes in adult ADHD and examine whether changes vary by gender. Method: We analyze data from the 2007 and 2012 U.S. National Health Interview Survey. Results: The prevalence of ADHD among adults aged 18 to 64 years increased from 3.41% in 2007 to 4.25% in 2012. As expected, patterns of inter- and intra-cohort change varied by gender. At younger ages, inter-cohort gender differences are more distinct due to a spike in prevalence among boys/men born in or after 1980. Consistent with a gender-specific historical period effect, recent intra-cohort increases among women have narrowed the gender gap. Conclusion: The gender gap in the prevalence of ADHD among adults decreased by 31.1% from 2007 to 2012 due to increased prevalence among adult women of all ages. We discuss these results in relation to diagnostic practice, adult health and well-being, data limitations and needs, and directions for future research.

Medicalization's Communicative Infrastructure: Seventy Years of "Brain Chemistry" in the New York Times

Medicalization theory aims to delineate how and why non-medical issues become demarcated within the realm of medical jurisdiction. The theory postulates that medicalization is marked by diagnostic naming, medical expertise, technological standardization and the de-contextualization of experiential knowledge, and that it is driven by popular media and lay discourse as much as by the communication of health professionals and medical institutions. Although medicalization has been recognized as an inherently rhetorical act, medicalization theory does not attend to the specific communicative means undergirding its orchestration. Drawing from medicalized New York Times coverage of the phrase "brain chemistry" (N = 71), we address this theoretical aperture, identifying through rhetorical analysis the most common communicative devices that emerged across 70 years of coverage and three distinct diagnoses (i.e., mental illness, addiction and overweight/obesity). Our findings reveal three central rhetorical means through which medicalization is communicated including mechanical metaphor, pedagogy of contrast, and moral enthymeme. By tracing content across time, the current study explicates the communicative infrastructure that gives rise to medicalization, thereby extending the literature from questions of why medicalization occurs and what its content is to how it is conveyed and imparted.

How Did Erectile Dysfunction Become "Natural"? A Review of the Critical Social Scientific Literature on Medical Treatment for Male Sexual Dysfunction

This article reviews the multidisciplinary social science literature assessing the social consequences of medical treatment for male sexual dysfunction. This literature applies medicalization theory and social constructionist approaches to gender to assert that Euro-American cultural ideals of masculinity and sexuality, as well as ageism and ableism, determine which sexual changes and experiences get defined as "dysfunction" and shape the marketing and use of medical treatments for those changes. These medical responses assuage the suffering of men who become unable to meet cultural ideals for sexuality but in the process make reductive norms for male sexuality seem biologically natural. In addition, the critical social science research suggests that an economic logic underlies the process of redefining diversity and change in men's sexual function as medical pathology. However, comparative qualitative data on men's and their sexual partners' experiences of sexuality and aging across world regions suggest that people do not universally accept the narrow ideals of male sexuality embedded in medical discourse regarding men's sexual dysfunction. The diversity in people's sexual desires across the life course and their responses to sexual function change highlight the cultural nature of medical definitions of sexual dysfunction.

'I don't consider a cup performance; I consider it a test': masculinity and the medicalisation of infertility

Researchers have deemed medicalisation a 'gendered' theory, yet the incorporation of men and masculinity in medicalisation literature is sparse. Recently, however, medicalisation scholarship has begun studying men. This burgeoning literature heavily emphasises sexuality and is beginning to focus on medicalised masculinities in which traits associated with masculinity are deemed a health risk. Such research has demonstrated how masculinities shape men's lived experiences of health, but how does health itself shape masculinity? I explore this question using the case of infertility. Through thirty in-depth interviews, I find that men use medicine as a way to achieve rather than diminish their sense of masculinity in the feminised context of reproduction. By perpetuating the stereotype that infertility is a woman's problem, the medical establishment has caused men to not necessarily see themselves as infertile. Additionally, even if men do claim the infertility status, they do not perceive it as negative. The legitimating effects of medicalisation objectify the ailment and separate its connection with sexuality. In centring men's voices, the study not only reveals men as active players in the reproductive process, but also incorporates them into understandings of medicalisation.

Gender and health control beliefs among middle-aged and older adults

OBJECTIVE

Internal health locus of control (HLOC) reflects individuals' beliefs that their own behavior influences their health. This study explores the gender difference in internal HLOC among middle-aged and older adults.

METHOD

Using data from two waves of the National Survey of Midlife Development in the United States (MIDUS; N = 1,748), I estimate two-level random-intercept models predicting internal HLOC.

RESULTS

Women report higher levels of health control beliefs than men, especially in older cohorts born in the 1920s and 1930s. Adjustment for health, socioeconomic status, generalized control, and masculinity increases this gender gap, whereas adjustment for femininity and religiosity significantly reduces this difference. Women's higher religiosity and more feminine traits, such as warmth, nurturance, and care, partly explain their higher internal HLOC relative to men.

DISCUSSION

Because femininity and religiosity are positively associated with other-orientation, interventions to increase communal orientation may enhance beliefs in proactive responsibility for one's health among older adults.

MORE AND LESS THAN EQUAL: How Men Factor in the Reproductive Equation

In both social science and medicine, research on reproduction generally focuses on women. In this article, we examine how men's reproductive contributions are understood. We develop an analytic framework that brings together Cynthia Daniels' conceptualization of reproductive masculinity (2006) with a staged view of reproduction, where the stages include the period before conception, conception, gestation, and birth. Drawing on data from two medical sites that are oriented to the period before pregnancy (preconception health care and sperm banks), we examine how gendered knowledge about reproduction produces different reproductive equations in different stages of the reproductive process. We conclude with a new research agenda that emerges from rethinking the role of men and masculinity in reproduction.

Gender policies and advertising and marketing practices that affect women's health

BACKGROUND

The three papers of this doctoral thesis are based on the social construction of reality through the analysis of communication relating to health issues. We have analysed the contents of parliamentary, institutional, and mass media to uncover whether their communications create, transmit, and perpetuate gender biases and/or stereotypes, which may have an impact on peoples' health, with a particular focus on women.

OBJECTIVE

To analyse decision making and the creation of gender awareness policies and actions affecting women's health: (1) political debates about abortion, (2) gender awareness communication campaigns and educational actions, and (3) pharmaceutical advertising strategies.

DESIGN

Quantitative and qualitative methods were employed, and the research included observational studies and systematic reviews. To apply a gender perspective, we used the level of gender observation proposed by S. Harding, which states that: (1) gender is the basis of social norms and (2) gender is one of the organisers of the social structure.

RESULTS

Sixty percentage of the bills concerning abortion introduced in the Spanish Parliament were initiated and led by pro-choice women's groups. Seventy-nine percent of institutional initiatives aimed at promoting equality awareness and were in the form of educational actions, while unconventional advertising accounted for 6 percent. Both initiatives focused on occupational equality, and very few actions addressed issues such as shared responsibility or public policy. With regard to pharmaceutical advertising, similar traditional male-female gender roles were used between 1975 and 2005.

CONCLUSIONS

Gender sensitivity continues to be essential in changing the established gender system in Spanish institutions, which has a direct and indirect impact on health. Greater participation of women in public policy and decision-making are critical for womens' health, such as the issue of abortion. The predominance of women as the target group of institutional gender awareness campaigns proves that the gender perspective still lacks the promotion of shared responsibilities between men and women. There is a need for institutions that act as 'policy watchdogs' to control the gender biases in mass media and pharmaceutical marketing as well as to ensure the proper implementation and maintenance of Spanish equality laws.

Between negative stigma (cultural deprivation) and positive stigma (learning disability): the historical development of two special education tracks

This article posits an updated, broader perspective on the concept of learning disabilities (LDs) than that accepted in the local Israeli literature, revealing how it is immersed in class, ethnicity, and culture. This is shown through historical description, accreditation, and contrasting of the two special education discourses: the "cultural deprivation" discourse and the "LDs" discourse. There are three sections. Part One presents the theoretical, conceptual, and methodological background of the sociological and discursive debate about LDs. The social-constructivist model used in an analysis of the two categories is proposed as an alternative to the clinical-medical model. The definitions of LDs and cultural deprivation accepted in the Israeli discourse are presented in Part Two. The metamorphoses in the discourse about the category of LDs are uncovered through reference to their conceptual and historical antecedents. This part discusses the various understandings and constructions of learning difficulties. Part Three examines the textual representation of parents of children with disabilities in both cases, exploring the meanings of guilt, responsibility, and agency in each discourse. The conclusion clarifies the social and political significance of the distinct textual and rhetorical representations. It becomes evident that the discourse on LDs and the discourse on cultural deprivation are two special education tracks directed at different target audiences: the culturally enriched audience, well-off and educated on the one hand, and the Mizrahi audience of limited means and education on the other hand.

Quality of pharmaceutical advertising and gender bias in medical journals (1998-2008): a review of the scientific literature

OBJECTIVE

To review the scientific literature on pharmaceutical advertising aimed at health professionals in order to determine whether gender bias has decreased and the quality of information in pharmaceutical advertising has improved over time.

METHODS

We performed a content analysis of original articles dealing with medical drug promotion (1998-2008), according to quality criteria such as (a) the number, validity and accessibility of bibliographic references provided in pharmaceutical advertising and (b) the extent to which gender representations were consistent with the prevalence of the diseases. Databases: PUBMED, Medline, Scopus, Sociological Abstract, Eric and LILACS.

RESULTS

We reviewed 31 articles that analyzed advertising in medical journals from 1975-2005 and were published between 1998 and 2008. We found that the number of references used to support pharmaceutical advertising claims increased from 1975 but that 50% of these references were not valid. There was a tendency to depict men in paid productive roles, while women appeared inside the home or in non-occupational social contexts. Advertisements for psychotropic and cardiovascular drugs overrepresented women and men respectively.

CONCLUSIONS

The use of bibliographic references increased between 1998 and 2008. However, representation of traditional male-female roles was similar in 1975 and 2005. Pharmaceutical advertisements may contribute to reinforcing the perception that certain diseases are associated with the most frequently portrayed sex.

A comparison of blogs by depressed men and women

This paper reports on a study comparing Internet blogs written by 45 men and 45 women who self-identified as depressed. Using qualitative and inductive methods, distinct differences among the male and female experiences of depression were documented. Among the most important differences were the distinctions male and female bloggers made in regards to (1) the bio-medicalization of depression; (2) the relative significance of world events as compared to relationships in depression experiences; and (3) violence, including suicide and cutting. Theoretical reasons and explanations for these findings are discussed.

Developments in Scandinavian and American medical sociology

This paper examines the similarities and differences in Scandinavian and American medical sociology. First, the issue of medicalization has not been as important in Scandinavian as it has been in American medical sociology. Second, women's health has been less explored in Scandinavian than in American medical sociology. Third, research on social inequalities and health has been a major focus in Scandinavian medical sociology since the 1990s. Fourth, cultural sociology and the poststructuralist perspective have been part of mainstream theory building in European sociology and also European and Scandinavian medical sociology during the past decade, while American medical sociology has been characterized by social-role theory and a quantitative approach.