«The Social Control of Childhood Behavior via Criminalization or Medicalization: Why Race Matters DISSERTATION Presented in Partial Fulfillment of the ...»
Through the expansion of the Diagnostic and Statistical Manual of Mental Disorders, or DSM, mental health professionals have introduced a growing number of new mental and behavioral disorders to describe a range of human behavior and emotions and revised many symptom thresholds for existing disorders to accommodate more patients (Mayes and Rafalovich 2007; Whooley 2010). At the same time, scholars have noted a marked increase in direct to consumer advertising of treatments for a number of common ailments (Conrad 2005; Conrad and Barker 2010). As a result, the use of diagnosis, therapy, and/or psychotropic medication as a way to define and control children viewed as troublesome has increased over the past twenty-five years (Conrad 2007). In particular, the use of stimulant medication to control symptoms of ADHD, including Ritalin, Adderall, or Dexedrine, is ten times higher now than it was in 1990 (Centers for Disease Control [CDC] 2010; Conrad 2013; Millichamp 2010; Setlik, Bond, and Ho 2009; Thomas et al. 2006). Indeed, ADHD is the most commonly diagnosed disorder among children between the ages of 6 and 14 in the United States (CDC 2012).
As a boy’s behaviors become defined and managed using medical terms and technology, that boy and his family risk stigma and possible social exclusion as people are made aware of his disorder (Link and Phelan 2001, 2006; Thoits 2011). However, proponents of medicalization argue that pharmaceutical treatment improves classroom performance by improving attention and concentration and, in many cases, resulting in better behavior (Barkley 2002; Millichamp 2010). When boys are adhering to their behavioral or pharmaceutical regimens, they report more ease and comfort during routine social interactions with their parents and peers (Barkley 2002). Furthermore, medicalized boys report better short-term impulse control, reducing incidents of classroom disruption (Barkley 1997; McDonagh et al. 2007), particularly when medication is combined with behavioral therapy (Barkley 2002). These benefits suggest that medicalization may be a more advantageous means of social control than other, more punitive measures (Conrad 1992a; Medina and McCranie 2011; Zola 1974).
The processes of criminalization and medicalization have given rise to a multiinstitutional approach to the social construction of child behavior that reflects important societal perceptions and priorities (Conrad 2013; Conrad 1992a; Medina and McCranie 2011). Specifically, the decision to punish and/or treat a young man is a complex process that involves much more than his misbehavior. The social construction of his behavior takes into account attributes of the young man himself, his perceived threat to the community, and important social and structural factors that constrain the decision making process (Steffensmeier, Ulmer, and Kramer 1998; Link and Phelan 2001). To help explain how the behavior of young malesis socially constructed, I turn to a discussion on the focal concerns of claims-making institutions (Steffensmeier, Ulmer, and Kramer 1998).
The Focal Concerns of Social Construction Steffensmeier and colleagues (1998) posited that judges and other actors in the criminal justice system had three focal concerns when deciding on criminal sentences: the offender’s blameworthiness, protection of the community, and practical implications and constraints in the decision making process. Blameworthiness involves the assessment of defendant’s guilt and the perceived need for retribution. Defendants who commit more serious offenses are perceived to have caused great harm and are thus more likely to receive longer and harsher sentences (Chiricos et al. 2007; Huebner and Bynum 2006;
Steffensmeier, Ulmer, and Kramer 1998). On the other hand, mitigating factors such as a history of abuse or mental health problems can limit blameworthiness and reduce sentence severity (Heubner and Bynum 2006; Steffensmeier, Ulmer, and Kramer 1998).
In addition to perceptions of culpability, courtroom actors typically impose longer sentences on those they view as threatening to the community and in need of exclusion and isolation (Steffensmeier, Ulmer, and Kramer 1998). However, defendants viewed as low-risk or willing to cooperate with authority were often treated with leniency when the nature of the offense was less severe (Johnson and DiPietro 2012; Steffensmeier, Ulmer, and Kramer 1998).
Despite the relatively straightforwardness of perceived guilt and risk, judges and other actors rarely have total information about offenses and defendants (Steffensmeier, Ulmer, and Kramer 1998). Instead, they rely on cues drawn from characteristics external to the actual offense, including the race of the offender (Engen et al. 2002; Soung 2011;
Steffensmeier, Ulmer, and Kramer 1998). Furthermore, courtroom actors are constrained in these decisions by state and local economic resources such as available prison space and political climate (Johnson and DiPietro 2012; Steffensmeier, Ulmer, and Kramer 1998). Although this focal concern framework has not been directly applied to school punishment or the decision to seek a medical therapy or medication, research routinely underscores the importance of blameworthiness, perceptions of threat, and structural constraints in the social construction of child misbehavior.
Blameworthiness The imposition of the criminal justice model on school discipline establishes blame and personal responsibility as central to the justification for harsh school punishment (Simon 2007). Students who commit more serious offenses, such as fighting or drug use, are much more likely to be removed from school for longer periods of time than students who commit relatively minor offenses (Kupchik 2010; Skiba et al. 2013).
Boys who are considered extremely disruptive or disrespectful are more likely to be removed from the classroom and receive in-school suspensions (Ferguson 2001; Gregory and Weinstein 2008; Kupchik 2010; Skiba et al. 2013). For lesser offenses in particular, perceptions of blameworthiness are subject to the discretion of teachers and school administrators. Similar to the criminal justice system, these perceptions extend beyond the offending behavior to include cues based on personal biases, including preconceived notions of race and class (Ferguson 2001; Kupchik 2010; Monroe 2008; Skiba et al.
While school punishment is meant to serve as retribution for violating school rules, medicalization is intended to reduce individual responsibility and blame (Conrad 1992a; Link and Phelan 2010; Kvaale, Gottdiener, and Haslam 2013; Medina and McCranie 2011). If misbehavior is considered the result of an underlying behavioral or conduct disorder, adults are less likely to hold that child personally accountable for his actions and more likely to blame them on his disorder (Bussing et al. 2012; Conrad 1992a; Kvaale, Haslam, and Gottdiener 2013). If adults blame a young man’s misbehavior on a medical or psychological cause, the perceived need for retribution declines. Instead, they may try to rehabilitate the young man by seeking out medication or therapy to control the medical or psychological issue responsible for his misbehavior (Conrad 1992a; Rafalovich 2013).
Perception of Threat School administrators argue that they must provide a safe and effective learning environment, and harsh discipline and removal of troublemakers is an essential tool for this task (Kupchik 2010). However, in many cases, this perception of danger extends beyond the risk of harm to other students and teachers. The use of harsh discipline has been a useful tool in removing students considered threatening to the process of education itself (Kupchik 2010). Students who are perceived as unwilling to learn or cooperate in a classroom setting can be forcibly removed from school without causing actually threatening any other person’s physical safety (Ferguson 2001; Skiba et al.
2013). Indeed, more students are suspended for offenses like classroom disruption and tardiness than for fighting and weapons (Kupchik 2010; Skiba et al. 2013). In many cases, school suspension or expulsion for relatively small offenses can also help administrators remove failing students from the roster and improve the school’s overall performance on important funding metrics, including standardized test scores (Skiba et al. 2013).
While suspension and expulsion excludes a young man from his classroom and isolates him from his peers, medicalization presents an attempt at managing behavior while keeping him involved in normal school activities (Conrad 1992a; Medina and McCranie 2011). For example, when adults view a young man as sick rather than bad, they may be less likely to consider his behavior threatening when it can be controlled through therapy and medicalization (Medina and McCranie 2011; Perry et al. 2007).
When a young man is viewed as able and willing to participate in medical treatment and therapy, he is more likely to be kept in class with his peers (Conrad 1992a; Kvaale, Haslam, and Gottdiener 2013; Thoits 2011). Indeed, American public schools are legally bound to consider whether misbehavior can be blamed on a medically diagnosed disorder when making disciplinary decisions about medicalized young males (Kim, Losen, and Hewitt 2010).
Social and Structural Constraints The social construction of a young boy’s misbehavior is limited by several political and socioeconomic factors. For example, the implementation of zero tolerance policies and increases in school suspension and expulsion have historically been concentrated in inner-city schools across the country (Lyons and Drew 2006; Skiba et al.
2013). Eager to be seen as responsive to perceived spikes in urban youth violence, “tough on crime” policymakers support and fund those schools that develop the most effective discipline plans, often measured by the number of classroom and school removals (Lyons and Drew 2006; Simon 2007). For boys attending these schools, even the most minor rule violation runs the risk of punishment (Ferguson 2001; Skiba et al.
2013). Moreover, many disadvantaged children attend schools with limited resources for dealing with growing pressures of high-stakes testing. As a result, young maleswith educational or behavioral difficulties and limited resources risk being suspended or expelled from school in efforts to improve the school’s overall performance (Skiba et al.
Similar political and economic factors are behind the medicalization of misbehavior. With the passage the FDA Modernization Act of 1997, direct to consumer advertising became an increasingly effective way for pharmaceutical companies to market behavioral treatments to parents (Conrad 2007; Conrad and Barker 2010).
Similar to other changes in healthcare laws and technology, members of socially advantaged groups are in a much better positive to take advantage of these changes (Conrad and Potter 2004; Goldman and Lakdawalla 2005; Link and Phelan 1995).
Additionally, parents’ with greater social and economic resources can influence how teachers and administrators apply the rules towards their children (Kupchik 2010). For example, by being able to provide their children with extracurricular activities and resources to help with their academics, parents are able to promote an image of their child as serious about academics (Kupchik 2010; Lareau 2002; Lareau and Munoz 2012).
Furthermore, this gives children the social resources to interact with adults in a reasoned, conversational manner, rather than passively accept sanctions and consequences (Kupchik 2010; Lareau and Munoz 2012). Consequently, parents and teachers are more likely to work together to develop a behavioral or educational plan that can meet the young man’s needs rather than simply removing him from school.
To summarize, the social construction of childhood misbehavior shares many of the same focal concerns as the criminal sentencing process in the criminal court process. The criminalization and/or medicalization of a boy’s misbehavior involves how culpable adults consider him to be for his actions, how dangerous he is thought to be to others, and the resources that parents and teachers have at their disposal. Importantly, similar to the criminal justice system, the focal concerns of many parents and teachers are heavily patterned by a racialized social structure that allows young African-American men to be routinely stereotyped as delinquent and dangerous while young White boys are better able to maintain their childlike innocence (Ferguson 2001; Soung 2011;
Steffensmeier, Ulmer, and Kramer 1998). In the next section, I turn to discussions of labeling theory and cumulative disadvantage/disadvantage to help explain racial disparities in the social construction of child misbehavior within a focal concerns framework.
Race and Criminalization Labeling Theory According to labeling theory, decisions determining whether behaviors are viewed as normal or deviant are made by the dominant group (Bernburg 2009;
Paternoster and Iovanni 1989). As a result, subordinate and minority groups are particularly vulnerable to social control and punishment (Paternoster and Iovanni 1989).
In the United States, young African-American men are arrested, convicted, and incarcerated at extraordinarily high rates relative to other social groups (Western 2006).
This mark of criminality extends elsewhere, leading to stereotypes of young AfricanAmerican men as criminals and therefore more worthy of blame for problem behavior than young White men (Engen et al. 2002; Soung 2011). From early ages, the perception of African-American boys among larger society is that of criminal or threatening (Engen et al. 2002; Ferguson 2001; Rios 2006; Soung 2011).