Medicalization in Nepal: A Study of the Influence of Westernization on Defining Deviant and Illness Behavior in a Developing Country

Article excerpt

With the modernization of developing societies, scholars, academics, and activists are concerned about the effects of Westernization and how people in these societies see the world and develop a sense of meaning in light of the rapid and often broad-sweeping social and cultural changes. As nonindustrial societies adopt the artifacts and systems characteristic of Western cultures, concerns have been raised regarding their impact on the consciousness, perceptions, and ideologies of people in these societies. In this regard, it is important to consider how the introduction of Western technologies, taste expressions (e.g., music), and social organizations (e.g., bureaucratic organization) influence people's consciousness, and their sense of themselves.

Modernization is framed, typically, in terms of the increasing rationalization of traditional cultures. Whereas traditional cultures generally orient meaning through religion, myth, and traditional value-based knowledge, Western cultures are more likely to require knowledge to be justified in terms of principles, procedures, and outcomes within the context of bureaucratic organization, scientific logic, and goal-based achievement. Social systems and behavior in developing countries are often transformed by the application of rational designs that are introduced by Western-oriented agencies. As a society follows a rationalized model for development, there is a general tendency for all institutions, and most areas of life, to be affected.

One important issue of Western rationalization concerns the possible changes to the process of serf-definition, defining one's self from the perspective of the traditional culture in which one was born versus a perspective influenced by Western ideas and values. Although there is considerable variation, the non-Western notion of sense of self is generally rooted in a higher degree of embeddedness of the self in society. The self is oriented toward others, and maintaining harmonious social ties is usually more important than individual success (Nisbett 2003). In non-Western cultures such as Nepal, the individual is not perceived to be a unitary free agent, as in the West. Instead, the definition of self is more a function of social context. One concern of Westernization is the implication of a change in emphasis on the self as defined by its relationship to others, to one that separates individuals from their social contexts and stresses a definitive and unique self-hood (Peltzer 2002). Individuals in Western culture are far more likely to be understood as having self-directed and "rational choice" governance over their behavior than in non-Western cultures. Deviant behavior, consequently, is more likely in the West than elsewhere to be explained in reductionist and often medical terms, for instance, as some fault within the individual actor. How this process may develop in Westernizing societies is the focus of this study.

Medicalization and Culture

Defining deviant behavior in reductionist and medical language is believed to be a product of rationality-based Western cultures that are industrialized (or post-industrial), bureaucratic, generally secularized, and rooted in individualism, and is rare in non-Western, pre-industrial cultures (Conrad 1992). Medicalization refers to the process by which non-medical conditions become defined and treated as medical problems, usually in terms of illnesses and disorders (Conrad 1992). In short, medicalization is the process that awards jurisdiction of behavioral and social problems to the medical institution.

Using a medical rubric to frame social and behavior problems has a number of important implications and has been of concern to social scientists for many years. The main criticism of the medicalization process relevant to this study centers on the ways in which the medical model decontexualizes social problems and individual behavior (Waitzkin 1993). Classifying behavior and social conditions as an expression of illness is criticized as overly reductionistic and removes the social environment from having any influence on the condition. …