De-Medicalizing Addiction: Toward Biocultural Understandings

Purpose – This chapter critically examines efforts to destigmatize addiction through the creation of a diagnostic category and medicalization. It further critiques “realist” accounts of neuro-scientific knowledge, proposing instead a “biocultural” framework that enables a more multifaceted understanding of drug problems that leads back to questions of biopolitics.

Methodology/approach – After showing that medicalization is not always associated with destigmatization, this chapter reviews evidence suggesting that the social class of drug users is central to questions of stigma. A literature review concerning social constructionist approaches to bodies is then offered, culminating in an exploration of “biocultural” frames and their implications for psychiatric knowledge.

Findings – The material world can only be grasped through a cultural frame, an understanding that challenges “realist” accounts of knowledge. While making reference to brain functioning, psychiatric “disorders” in fact identify violations of interpersonal or psychic norms. These violations cannot be linked in a linear way to patterns of brain activity, even at a theoretical level.

Social implications – This chapter points toward a way of analyzing psychiatric disorders that allows for and highlights their political effects. Without ruling out medical interventions, it suggests that clinical and social understandings are an essential component of psychiatric understanding.

Originality/value of chapter – While “biocultural” approaches have been proposed by other social theorists, this chapter applies the frame in new ways to the psychiatric endeavor. In the face of increasing medicalization within the field of psychiatry, this chapter makes a strong theoretical case concerning the value of clinical and social knowledge concerning psychiatric disorders.