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The premise of this collection of writings is that medicalization theory, so prominent in problematizing women's health, has ignored the medicalization of men's bodies. In their introduction editors Rosenfeld and Faircloth acknowledge that this is a startling hypothesis, given the volume of scholarship on medicalization. Men's behavior as a health risk has become standard fare in health related research (failure to seek medical advice, risk taking, substance use), but as Rosenfeld and Faircloth argue, it is most improbable that men's bodies have completely escaped the medical gaze. The lack of research in masculinization presents two problems: one is to explain and theorize this absence, and the other is to fill the gap with studies that bring examples of the phenomenon to light. Most of this book addresses the second of these problems, with the editors presenting a theoretical framework to guide the development of research and analysis.
Successive contributors show that the price of the normalized male body as the benchmark for scientific investigation has been the glossing over of increasing medicalization of men. The book covers a wide range of issues, from the relatively mundane but not unimportant issue of "treatment" for baldness, to the more ethically disturbing medicalization of boyhood through the psychiatric label of attention deficit hyperactivity disorder (ADHD). Readers will be familiar with the celebrity endorsements for Viagra and Cialis. You only have to open your inbox to experience the saturation marketing of these drugs. Other issues, such as the study of anatomy, do not present themselves so readily to the man in the street. And while most academics have read of the decades long Tuskegee syphilis experiment, few will have given this issue the degree of analysis provided in this book.
Medicalized Masculinities contains eight chapters, each brief enough to be read in an hour or so, and sufficiently self contained to be read independently. The editors provide an introduction with an historical overview of medicalization scholarship and theoretical approaches. The remaining chapters examine specific examples of medicalization. The contributors are either sociologists or health researchers taking a sociological analysis. The tenor of the book is critical, especially of medicine, but the theoretical frameworks, broadly Foucaldian, are sensitive to the complicity and active contribution of a wide range of interests in the medicalization process. The medicalization of masculinity is not a case of unilaterally imposed medical authority. As the case of ADHD shows, medicine has been captured by education, advocacy groups, medical technology, and other influences, and has been passive in accepting the word of teachers and mothers that increasing numbers of young boys are mentally ill and need treatment.
Behind the whole process of medicalization stands the pharmaceutical industry, ready with a range of persuasive arguments aimed not necessarily at medical professionals, but increasingly directly at the public. Medicalization is so much more efficient if patients present to doctors already convinced they have a medical problem and aware of the necessary treatment. Direct marketing, while appealing to medical discourse, is not necessarily supportive of medical authority, creating a central contradiction in the medicalization process. If anything, many of the examples in this book point to a decline in the power of medical professionals in the definition of illness. The rewards of a profit driven health sector, especially in the US, ensure that there is little in the way of professional resistance to the undermining of medical authority.
Following Rosenfeld and Faircloth's introduction, the first two chapters explore the male virility drugs Viagra, Cialis and Levitra. Linked to a socially conditioned and pervasive male desire for youth and sexual performance, these chapters show how clever marketing creates the "problem" of the sustained erection. Canny marketing draws on new claims for virility drugs to expand markets, and to medicalize sexual concerns for wider (and younger) groups of men. Lisa Moore and Heidi Durkin tackle the issue of forensic analysis of male body fluids, arguing that this new area of science is increasingly displacing women's testimony, as DNA provides a positivist alternative to the "untrustworthy" narratives of female victims. This is an intriguing argument, as there are clearly cases in which science has identified offenders who might otherwise have escaped justice. DNA evidence has also exonerated many men who have spent long terms in prison following flawed convictions. Moore and Durking show that enthusiasm for these advances needs to be tempered with wider awareness of its effects.
Julia Szymczak and Peter Conrad discuss the newly invented male "diseases" of andropause and baldness. Both these "conditions" are driven by extensive market interests, and represent a commercialization of medicine. As other contributors also show, this form of medicalization is by no means imposed by doctors on a skeptical male public. Men themselves actively contribute through their readiness to seek medical solutions to life issues. Szymczak and Conrad predict that this process will continue as more wealthy baby boomers hit old age. The chapter on anatomy is interesting in that it brings to light an often secretive area of medicine, the use of cadavers for teaching medical students. This is a chapter which would fit easily into a text of feminist critique of medicine, as it explores the masculinist assumptions of traditional approaches to teaching anatomy. Alan Petersen and Sam de Bere introduce some new advances in anatomy which have the potential to displace the traditional dissection room with simulations, live subjects, and virtual technology.
The longest chapter in the book presents an extended analysis of ADHD in the United States. Authors Nicky Hart, Noah Grand and Kevin Riley assemble a large array of evidence that points to ADHD as an expression of upper middle class anxiety about the socialization of boys, built on massive changes in the female labor force and reduced availability of female labor in the domestic sphere. Sales of the ADHD drug Ritalin have skyrocketed in response to these changes. The argument is compelling, that ADHD is largely socially constructed, and confined to a minority of boys predominantly of wealthier than average families. Anne Marie Hickey's study of black masculinity draws heavily on the Tuskegee syphilis experiment to show that this travesty has left a legacy of culturally entrenched racial stereotypes and distrust of the medical profession. One reason for this is that the Tuskegee experiment was not confined to the year in which it began (an impression created by many reports that talk of the "1932 Tuskegee experiment", but it continued for decades, even surviving the Nuremberg trials. Hickey's chapter illustrates that medicalization of masculinity is not a uniquely late twentieth century phenomenon. The final chapter is an exploration of Post Traumatic Stress Disorder (PTSD), a psychiatric category that has more than its share of critics. Marisa Smith posits an interesting contradiction: that medical discourse in the area of PTSD is somewhat Janus faced. Analyzing responses to group therapy for Vietnam veterans, Smith argues that views of masculinity are simultaneously problematic in contributing to PTSD, and yet plastic enough to provide part of the solution.
Inevitably there are areas of medicalization not covered. Suzuki in his history of madness in Victorian in England (Madness at Home) documented recognizable male models of madness, and Elaine Showalter (The Female Malady) described neurasthenia as "male hysteria". The medicalization of homosexuality is another example, also illustrating one of the books minor themes, demedicalization, as various "disorders" are reinterpreted. The more contemporary example of body dysmorphic disorder, while perhaps not a classical example of medicalization of masculinity, is certainly one that idealizes a particular male body, and rests on the social construction of the male body. Another issue deserving research is the medicalization of risk, especially in the psychiatric labeling of sexual offenders.
Medicalized Masculinities brings together a disparate set of examples. Together they support Rosenfeld and Faircloth's hypothesis that men's bodies are becoming increasingly medicalized, and that this issue has been ignored, sometimes because such a hypothesis has not fitted accepted theories of gender politics or medicalization. The issues of medicalization for men may be different than those for women. Clearly a grand theory of male domination will not apply here. The book is not excessively theoretical; the contributions are clearly written and well argued. The editors have done a good job in producing an even and accessible introduction to the medicalization of masculinity, and have provided ample references to classical works and current research. Medicalized Masculinities will be a valuable reference work for postgraduate health related courses. It will be of interest to health sociologists, but should be read by anyone with an interest in gender issues in health care, as well as by health practitioners in the specific areas addressed.
© 2007 Tony O'Brien
Tony O'Brien, RN, MPhil, Senior Lecturer, Mental Health Nursing, University of Auckland