International Journal of Drug Policy - 2014

Volume 25 Issue 3 May 2014

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Page 149 of 153

International Journal of Drug Policy 25 (2014) 650–652 Contents lists available at ScienceDirect International Journal of Drug Policy j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / d r u g p o Short report Remaking hospital space: The health care practices of injection drug users in New York City Kelly Szott a,b,∗ a Syracuse University, Department of Sociology, 302 Maxwell, Syracuse, NY 13244, USA b National Development and Research Institutes, Inc., Behavioral Sciences Training Program, 71 West 23rd Street, 4th Floor, New York, NY 10010, USA a r t i c l e i n f o Article history: Received 11 April 2013 Received in revised form 11 September 2013 Accepted 6 December 2013 Keywords: Injection drug users Health care Hospitals de Certeau a b s t r a c t Background: Medical care has long been depicted by social scientists as a field of social control, as well as a branch of Foucauldian disciplinary power. This report focuses attention on the hospital, a highly regulated place in the United States, and examines how injection drug users (IDUs) negotiate the medical social control and institutionalised disciplinary power they encounter in this place. Methods: Twenty-eight qualitative interviews were conducted in New York City with low-income peo- ple who inject drugs on a regular basis. Interview questions focused on their health and drug use and interactions with health care providers. Results: A variety of practices were employed to avoid, defy and subvert medical power. Study participants reported leaving the hospital when they felt ready rather than waiting to be discharged, actively seeking the type of care they wanted and ignoring medical advice. Conclusion: The hospital is not a site of total control in the narratives of IDUs, but rather a space to seek a self-determined amount and type of care. These results can re-orient providers of health care services towards understanding the productivity of the relationship between IDUs and the hospital. © 2013 Elsevier B.V. All rights reserved. Introduction Hospitals are often viewed as institutions of social control and disciplinary power, which becomes magnified when deviant bod- ies are the recipients of hospital services. Theories of medical social control and institutional disciplinary power elucidate the power relations within hospitals though they say little about resistance. This report uses de Certeau's (1984) theory of space and place to show how power and control situated in the hospital is dimin- ished through practices of avoidance, defiance and subversion by IDUs as they seek the amount and type of health care they deem appropriate. Dating back to Parsons' (1951) conceptualisation of the physician role and the sick role, the professional dominance of physicians and the concept of medical social control, served as analytic paradigms for conceptualising the social interactions of biomedicine. Recent theorisations of medical social control focus on the processes of medicalisation (Conrad, 2005) and biomed- icalisation (Clarke, Mamo, Fosket. Fishman, & Shim, 2010) and ∗ Corresponding author at: Correspondence to: Syracuse University, Department of Sociology, 302 Maxwell, Syracuse, NY 13244, USA. E-mail addresses:, place the origin of medical power in the activities of biotechnology and the capitalist market among other sources. Prior research on medical social control that examines the micro-politics of the doctor–patient relationship (such as Waitzkin, 1991) underscores the moral qualities of advice given by doctors. Especially relevant is a range of research that documents the stigmatisation and prejudice drug users experience in medical settings (Brenner, Von Hippel, Kippax, & Preacher, 2010; Butt, Paterson, & McGuinness, 2008; McCoy, 2010; Merrill, Rhodes, Deyo, Marlatt, & Bradley, 2002; Weiss, McCoy, Kluger, & Finkelstein, 2004). While the oper- ations of the hospital are undoubtedly imbued with capitalistic forces, as well as the goals of biotechnology, low-income drug users continue to experience the place of the hospital as a moral economy replete with stigmatising inquiries and exhortations aimed at normalising behaviour. Physician's moralised inquiries are indicative of disciplinary techniques of confession (Foucault, 1978) and indeed, hospital patients encounter institutional disciplinary power that aims to organise and manage them using an arsenal of tactics. According to Foucault (2007) the primary functions of hospital discipline con- sist of ". . .guaranteeing the inquiry, surveillance, and application of disciplines into the disorganized world of the patient and of ill- ness and in transforming the conditions of the environment which surrounds the patients" (p. 148). 0955-3959/$ – see front matter © 2013 Elsevier B.V. All rights reserved.

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