In this surprising book, Allan V. Horwitz argues that our current conceptions of mental illness as a disease fit only a small number of serious psychological conditions and that most conditions currently regarded as mental illness are cultural constructions, normal reactions to stressful social circumstances, or simply forms of deviant behavior.

This article looks at the relationship between logistical power and the assemblages of sites that constitute modern states. Rather than treating states as centralizing institutions and singular sites of power, we treat them as multi-sited. They gain power by using logistical methods of problem solving, using infrastructures to enforce and depersonalize relations of domination and limit the autonomy of elites. But states necessarily solve diverse problems by different means in multiple locations. So, educating children is not continuous with governing colonies (...) even though both are necessary to nineteenth-century states. For this reason, states use logistical means of coordination to link sites, and they make the power of the state seem unitary even though the exercise of state power is not. (shrink)

This article offers a critique and reconstruction of the concept of medicalization. Most researchers describe medicalization as the redefinition of social problems as medical concerns, and track its spread by the proliferation of disease language and diagnostic categories. Forensic psychiatry and disorders like psychopathy are often cited in these debates. I argue that focusing on discourse overlooks how medical language can justify or mask non-medical practices and outcomes, and lead researchers to identify medicalization where it has not occurred. Building on (...) other critiques of medicalization and recent studies of medical and legal expertise, I propose an alternative conception based on conditions for the performance of medical practice and other forms of expert labor. I distinguish the participation or intervention of medical practitioners from the medicalization of expert practice and identify several institutional factors that facilitate the latter. I illustrate this approach using a critical historical case: the first adult penal psychiatric clinic in the United States, founded by the eminent psychopathologist Bernard Glueck at New York’s Sing Sing Prison in 1916. Glueck’s extensive writings reveal little evidence of medicalization: psychopaths were largely defined and diagnosed according to penal rather than medical criteria, and they received additional punishment rather than treatment. A review of recent research confirms that psychopathy remains primarily a penal rather than medical condition. I conclude that focusing studies of medicalization on practice rather than discourse clarifies the concept and avoids reifying the notion of a medicalized society. (shrink)

A critical review of Bourdieu’s theory of the state is developed here against the backdrop of both his wider theoretical project and empirical studies. Elaborating the concepts of symbolic capital, symbolic violence, and symbolic domination, the centrality that Bourdieu accords to symbolic forms is compared to benchmark Weberian accounts that start with the state monopoly of violence. Reviewing also some of the burgeoning secondary literature discussing his theory of the state, Bourdieu’s writings, which encompass various antinomies, are shown to vacillate (...) between two distinct perspectives—a strong and a weak theory of the state. His rejection of the “physicalist” approaches of Marx, Elias, and Tilly is elaborated and subject to a counter-critique, particularly in relation to the notion of symbolic “violence.” Bourdieu’s account of the state is shown to be as much a political as theoretical intervention. His antagonism towards Marxist accounts in particular is shown to be rooted in a pragmatic interest in the role of the “left hand of the state” in progressive reform; and this perspective is traced back to the twin influences of Durkheim and Hegel, French republicanism, and in particular the potential of the state to express a universal interest. At the same time, compared with sophisticated Marxist and Weberian accounts and the work of Norbert Elias and Gramsci, Bourdieu’s theory is shown to be severely lacking in the way that he deals with violence and coercion. His “expanded materialism,” particularly with the “strong theory,” bends the stick too far and overplays the symbolic basis of consent. Nevertheless, Bourdieu’s insights with regard to the pervasive influences of state practices of classification, taxonomy, delegation, and naming are shown to have real utility with regard to focused empirical investigations of the state in modern societies. (shrink)

True to his longstanding bias against grand unifying theories, Hacking chooses to pursue these questions by focusing on a specific case of memory-thinking: the history of multiple personality. His excavation of the contemporary terrain leads him, however, to the surprisingly grand conclusion that the various sciences of memory—including neurological studies of localization, experimental studies of recall, and studies in the psychodynamics of memory—all emerged in connection with attempts to “scientize the soul,” as a result of which spiritual battles have been (...) recast as scientific controversies “where we suppose there is such a thing as knowledge to be had”. (shrink)

The Body Multiple is an extraordinary ethnography of an ordinary disease. Drawing on fieldwork in a Dutch university hospital, Annemarie Mol looks at the day-to-day diagnosis and treatment of atherosclerosis. A patient information leaflet might describe atherosclerosis as the gradual obstruction of the arteries, but in hospital practice this one medical condition appears to be many other things. From one moment, place, apparatus, specialty, or treatment, to the next, a slightly different “atherosclerosis” is being discussed, measured, observed, or stripped away. (...) This multiplicity does not imply fragmentation; instead, the disease is made to cohere through a range of tactics including transporting forms and files, making images, holding case conferences, and conducting doctor-patient conversations. The Body Multiple juxtaposes two distinct texts. Alongside Mol’s analysis of her ethnographic material—interviews with doctors and patients and observations of medical examinations, consultations, and operations—runs a parallel text in which she reflects on the relevant literature. Mol draws on medical anthropology, sociology, feminist theory, philosophy, and science and technology studies to reframe such issues as the disease-illness distinction, subject-object relations, boundaries, difference, situatedness, and ontology. In dialogue with one another, Mol’s two texts meditate on the multiplicity of reality-in-practice. Presenting philosophical reflections on the body and medical practice through vivid storytelling, The Body Multiple will be important to those in medical anthropology, philosophy, and the social study of science, technology, and medicine. (shrink)

This article investigates “impaired insight,” a controversial psychiatric category describing a mad person unable to know his or her madness. Like “moral insanity” and other concepts before it, impaired insight offers a way to link the disparate logics of human responsibility in psychiatry and the law. I attribute its development to changes wrought by deinstitutionalization, the rise of antipsychotic medication, and patient incarceration in penal settings. In a system that aims to govern psychiatric patients through their freedom, the logic of (...) impaired insight introduces a wrinkle: can a person make an informed choice to refuse treatment if madness itself impairs awareness of illness? Drawing on tools from the sociology of science, I trace the process by which researchers recast psychodynamic “denial” as a neurological and therefore non-volitional “impairment” in the 1990s. I then show how social movement actors mobilized the materialized form in the legal and policy fields in the 2000s, bringing insight science to bear upon the very questions of custodial management and patient rights that gave birth to it. At stake is this dilemma: how can societies that simultaneously privilege individual responsibility and somatic accounts of behavior govern those at the border of legal capacity, and with what justification? (shrink)

This article examines the cultural practices through which a group of professionals infuse their work and community with charisma. Although previous research has theorized the “charisma of office” (Weber 1978), we know little about how the occupants of such offices sustain it. I focus on a group of psychoanalytically-inclined psychotherapists, whose field, despite its early charismatic beginnings, has been especially embattled in recent decades. Drawing on ethnographic and interview data, I reveal how they share stories emphasizing their “idealization” by others, (...) draw boundaries between their professional and private lives to manage their work identities, and perform interpersonal affective work that shores up their claims to extraordinary abilities. Together, these cultural practices constitute charisma within the professional group. This article thus makes a case that, as expertise becomes increasingly contested, we must look beyond social organization and the evidentiary bases of knowledge to understand professional authority. (shrink)

To explore the limits of quantification as a form of rationalization, we examine a rare case of dequantification: race-based affirmative action in undergraduate admissions at the University of Michigan. Michigan adopted a policy of holistically reviewing undergraduate applications in 2003, after the US Supreme Court ruled unconstitutional its points-based admissions policy. Using archival and ethnographic data, we trace the adoption, evolution, and undoing of Michigan’s quantified system of admissions decision-making between 1964 and 2004. In a context in which opponents of (...) the system had legal avenues to engage a powerful outside authority, we argue that three internal features of the University’s quantified admissions policy contributed to its demise: its transparency, the instability of the categories it quantified, and the existence of qualitative alternatives. Our analysis challenges the presumed durability and inevitability of quantification by identifying its vulnerabilities and suggests that quantification should be understood as a matter of degree rather than a simple binary. (shrink)

Sociologists have challenged the discipline to account for and incorporate biological factors in their analyses. Heeding this call, this article asks how chimeras, a particularly puzzling biological organism, are being officially classified in the interrelated sites of endangered species preservation and the zoo. Based on a qualitative study of endeavors to clone endangered animals, I contend that biology alone cannot determine the classification of these interspecies organisms. Rather, categorizing chimeras requires metaphoric, schematic references to more familiar entities. Here culture and (...) biology are tools for classification, which has consequences for preservation practices and the materiality of endangered wildlife. Drawing on the sociology of culture, I show that positions on classification represent an intermediary space for interpreting the relationship between meaning and action in discourse elaboration. Building on the sociology of science and technology, I show the epistemological limitations of understanding the biological as an a priori factor. (shrink)