Putting a Name to It: Diagnosis in Contemporary Society

198 Pages·2011·1.603 MB·English

by  Annemarie Goldstein Jutel, Peter Conrad

Putting a Name to It
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Putting a Name to It
Diagnosis in Contemporary Society
Annemarie Goldstein Jutel
Victoria University of Wellington
Wellington, New Zealand
Foreword by Peter Conrad
Johns Hopkins University Press
Baltimore
© 2011 Johns Hopkins University Press
All rights reserved. Published 2011
Printed in the United States of America on acid-free paper
Johns Hopkins Paperback edition, 2014
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Johns Hopkins University Press
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The Library of Congress has cataloged
the hardcover edition of this book as follows:
Jutel, Annemarie.
Putting a name to it : diagnosis in contemporary society / Annemarie
Goldstein Jutel ; foreword by Peter Conrad.
p. cm.
Includes bibliographical references and index.
isbn-13: 978–1–4214–0067–9 (hardcover : alk. paper)
isbn-10: 1–4214–0067–7 (hardcover : alk. paper)
1. Social medicine. 2. Diagnosis—Social aspects. I. Title.
ra418.j88 2011
362.1—dc22 2010042464
A catalog record for this book is available from the British Library.
isbn-13: 978-1-4214-1574-1
isbn-10: 1-4214-1574-7
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post-consumer waste, whenever possible.
To my parents, Samuel Joseph Goldstein, Jr., and Carol Hirschler Goldstein
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Contents
Foreword, by Peter Conrad ix
Preface xi
Introduction: What’s in a Name? 1
A Place for a Sociology of Diagnosis? 5
An Avenue for Understanding 12
1 Lumping or Splitting: Classifi cation in Medical Diagnosis 15
The Aims of Classifi cation 18
Classifi cation of Diseases 20
Classifi cation Systems 26
Revealing Classifi catory Politics in Diagnosis 35
2 Social Framing and Diagnosis: Corpulence and Fetal Death 39
Corpulence 42
Fetal Death 51
Frame and Be Framed 59
3 What’s Wrong with Me? Diagnosis and the
Patient-Doctor Relationship 62
Illness and Disease 63
Medical Authority 67
Changing Roles in Diagnosis 68
What Next? 73
4 Beyond Our Ken? Contested Diagnoses and the
Medically Unexplained 76
Medically Unexplained Symptoms 80
Discovery of Disease 87
Whose Diagnosis? 93
Splitting from Diagnosis? 95
viii Contents
5 Driving Diagnosis: Peddlers and Pushers 97
Engines of Diagnosis 99
Female Hypoactive Sexual Desire Disorder 102
Discussion 112
6 “There Is Nothing So Small as to Escape Our Inquiry”:
Technologies of Diagnosis 117
Technology and Diagnostic Categories 118
Technology and the Diagnostic Process 122
Screening 126
Hope 132
Conclusion: Directions for the Sociology of Diagnosis 136
Creation 139
Application 140
Allocation 140
Exploitation 141
Moving Forward 142
Notes 147
References 149
Index 171
Foreword
Diagnosis constitutes the naming of an ailment or condition based on clas-
sifi cations that are embedded in extant medical knowledge. Diagnosis is a
critical feature of medicine, simultaneously identifying what is wrong, pro-
viding a roadmap for treatment options, and assessing possible outcomes
or prognoses. As the physician Michael Balint noted, diagnosis transforms
apparently random symptoms into an organized illness. Although diagnosis
is an emblematic medical event, Annemarie Jutel shows in this important
book that it is also an event with signifi cant social roots and consequences.
The process and impact of diagnosis has been an object of sociological
study for decades, but that study has not necessarily manifestly focused on
the development and application of the diagnosis itself. What Jutel does here
is bring together numerous strands of sociological work and link them to
articulate the social construction, framing, meaning, application, and con-
sequences of medical diagnosis. Some faces of diagnosis will be familiar to
social scientists; others are new and fresh.
While reading this book I was reminded how diagnosis, in other frames,
has been signifi cant to my own research. For example, the process of med-
icalization—the development of medical categories for previously nonmedi-
cal problems—is an important part of studying the development and conse-
quences of diagnosis. We can often see diff erent groups promoting or resisting
diagnostic categories. Diagnoses have histories and can refl ect cultural set-
tings. What happened to hysteria, and how did obesity become an illness?
Social circumstances may matter as well. Three decades ago, in a study of the
experience of epilepsy, the meaning of diagnosis emerged as central to illness
experience. We encountered individuals with a new diagnosis of epilepsy. For
some it was “Oh no, my life is ruined, who will marry me, who will employ
me?” while others responded, “It’s only epilepsy, whew, what a relief, I was
worried it was a brain tumor.” We have the same diagnosis with divergent
consequences.