Of Others Inside: Insanity, Addiction, and Belonging in America


Social science, and specifically sociological, approaches to health and illness have been typically bifurcated around a dichotomy between what, for convenience, we might call naturalism and social constructionism. Naturalistic explanations seek physical causes of health and illness on the assumption that disease can be effectively controlled or eliminated by targeted medical intervention. This approach historically involved treating the human body as a machine that could be manipulated by medical science without the distractions of such dubious entities as “mind” or “subjectivity.” The spectacular treatment of the infectious diseases of childhood in the late nineteenth and early twentieth century provides the ideal model of medical science and its therapeutic potency. Of course, critics of this vision of medical history argue that these treatments were successful only after the social and physical environment had been improved by the introduction of sewerage, clean water, and an adequate food supply. Perhaps more importantly in the present context, while the physical etiology for example of measles has been successfully identified, there is far less scientific consensus as to the physical “substance” that produces alcohol addiction or mental illness. Similarly, the quest to discover genes that explain specific forms of social deviance is like a fable from Don Quixote in the sense that deviancy, because it is paradoxically a product of law or moral convention, does not lend itself to such explanations. The classic sociological argument is that the search for a genetic explanation of deviancy involves a category mistake. As Emile Durkheim argued, social facts can be explained only by social facts. Is homosexuality a genetic disorder, a socially constructed category, or a lifestyle choice? Is there a gene to explain the prevalence of divorce in modern society? Perhaps, but first we need to find the gene that will explain the prevalence of matrimony. We tend to assume that matrimony needs no explanation simply because it is a “normal” relationship between men and women that has the blessing of the Law. We tend to look for naturalistic explanations in the social sciences only when phenomena appear to be untoward.


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