Drawing upon the developing literature on gender studies and on medicalization critique, this thesis explores the relationship of mutual shaping among diagnoses, therapeutic approaches and professional jurisdictions in the field of male sexual health. Nowadays, the very definition of health is no longer understood in terms of the mere absence of disease, but as the incessant quest for a complete physical, mental and social well-being. This implies a requalification of sex as a source of personal fulfillment and fundamental dimension of a successful and healthy lifestyle well into old age (Marshall, 2010). People who do not feel sexually gratified are, in fact, actively encouraged to seek treatment in order to achieve a ‘normal’ condition of heterosexuality, that excludes dissatisfaction, lack of interest in sex or inability to perform a proper coitus as dysfunctional and pathological (Marshall, 2002; Jackson, Scott, 2010). Along with this inflation of the public's expectations for sexual performance, health professionals are shaped like the "experts" in sexuality (Tiefer, 2007). As noted by Furedi (2006: 18): “the term 'sexual health' indicates that the conduct of intimate life has also become dominated by the medical [and psychological] imperative”. Medical and psychological authorities have then become the culturally approved leading gatekeepers of sexual knowledge and advice. Hence, their professional reach can be seen as determined by the “process of negotiation and conflict with other parties and social forces, for the control of the source of knowledge and professional services market” (Tousijn, 2000: 202). In this sense, the mechanisms which underpin the discovery and the development of a diagnosis and its treatment, are firmly grounded in the socio-cultural context that provides the backdrop for a diagnostic label to flourish and also in the complex web of interactions among lay people, professionals, institutions and stakeholders involved in these processes. This process of an ongoing coproduction among diagnoses, treatments, professional jurisdictions and embodied subjectivities is particularly evident in the male sexual health field. Evidence of these mechanisms can be, for instance, found in the hybrid and negotiated features (Anspach, 2011) of the actual diagnostic and therapeutic management of the main male sexual problems, namely erectile dysfunction (ED) and premature ejaculation (PE). These conditions can be be seen at an intersection where different contending specialties, such as the professions of andrologists and psycho-sexologists, both collaborate and compete to obtain a well- established role within the (male) sexual wellness field. Methodologically the work employs qualitative methods: analysis of scientific journals, text-books and awareness campaigns and 44 in-depth interviews with medical and psychological experts. The use of diagnostic and therapeutic repertoires as heuristic tools allows to highlight differences and similarities among diverse healing approaches which are actively involved in the social construction of masculinity. Specific attention is drawn to the role of pharmaceuticals designed for these male sexual problems, problematizing how (and to what extent) dealing with a range of supposedly “quick-fix” pharmaceutical devices, more or less effective in their promise to restore an adequate level of masculinity, can represent both an advantage and a constraint in their concrete management of male sexual dysfunction. In particular, the advent of the oral drugs for the treatment of impotence seems to have marked a deep watershed forcing the experts to employ new strategies to redefine their jurisdiction.

Questo lavoro di tesi dottorale è volto a descrivere i processi di co-costruzione che caratterizzano e sorreggono l'espansione diagnostico-terapeutica delle principali problematiche sessuali maschili. L'indagine si concentra sulle diagnosi della disfunzione erettile e dell'eiaculazione precoce, selezionate sia perché maggiormente diffuse a livello epidemiologico, sia perché, impedendo agli uomini la possibilità di condurre un rapporto sessuale “completo” contengono, nella loro stessa definizione, l'idea di performance sessuale normale, adeguata e ottimale (Tiefer, 2004; Marshall, 2006; Frith, 2015). Dal momento che nella “definizione della malattia” è contenuta la definizione della figura professionale legittimata ad occuparsene (Tousijn, 2000; 2009; 2013; Vicarelli, 2010), si sottolinea come solitamente la definizione della propria autorità giurisdizionale e i rapporti che su di essa sono costruiti non possano prescindere dalle definizioni diagnostiche e dalle linee terapeutiche derivanti proposte dalle diverse figure professionali in questo campo. Ciò appare importante a maggior ragione se si tiene conto del fatto che si ha in questo caso a che fare con problematiche sessuali la cui definizione e cura si strutturano in larga parte attorno al colloquio anamnestico con i pazienti-consumatori, portatori di vissuti soggettivi di illness e di abitudini e desideri sessuali di cui si deve tener conto per la stessa definizione contestuale/ibrida della diagnosi e della scelta terapeutica (Brown 1995; Jutel, 2009; Anspach, 2011). A partire da queste considerazioni, il focus di analisi è ricaduto sui repertori diagnostico-terapeutici relativi ai principali disagi della sessualità maschile che, come del resto gran parte delle problematiche legate alla qualità della vita, hanno subito nel tempo un notevole processo di espansione diagnostica altamente medicalizzata e farmacologizzata. I repertori diagnostico-terapeutici sono quindi stati utilizzati come strumenti euristici, intesi come un “prisma attraverso il quale produrre la diffrazione necessaria per destrutturare l'apparente compattezza del discorso scientifico” (Haraway, 1997/2000; cfr. Johnson et al., 2016: 314). L'intento non è tanto quello di illustrare le effettive pratiche diagnostico-terapeutiche in sé, quanto quello di delineare le modalità di descrizione, di interpretazione e di definizione di senso prodotte dai professionisti della salute sessuale (maschile) in modo da far emergere la dimensione normativa e di (auto)legittimazione (Orbuch, 1997) del loro operato e del loro ruolo di gatekeeping. Utilizzando una modalità di ricerca qualitativa, articolata attraverso la raccolta e l'analisi sia di materiale documentario che di interviste in profondità ad esperti del settore andro- e psico- sessuologico italiano, la questione è stata indagata a partire dai discorsi ufficiali e dagli accounts di quei saperi esperti che basano una larga parte del loro lavoro, e dunque della loro giurisdizione professionale, sulla patologizzazione dell'inadeguatezza sessuale maschile e sulla conseguente razionalizzazione terapizzata (Furedi, 2004; Jackson, Scott, 2010; Cacchioni, 2015) delle condotte sessuali e dei rapporti di genere.

(2017). La maschilità da curare. Dinamiche di costruzione di repertori diagnostico-terapeutici.. (Tesi di dottorato, Università degli Studi di Milano-Bicocca, 2017).

La maschilità da curare. Dinamiche di costruzione di repertori diagnostico-terapeutici.

SALIS, FRANCESCA
2017

Abstract

Drawing upon the developing literature on gender studies and on medicalization critique, this thesis explores the relationship of mutual shaping among diagnoses, therapeutic approaches and professional jurisdictions in the field of male sexual health. Nowadays, the very definition of health is no longer understood in terms of the mere absence of disease, but as the incessant quest for a complete physical, mental and social well-being. This implies a requalification of sex as a source of personal fulfillment and fundamental dimension of a successful and healthy lifestyle well into old age (Marshall, 2010). People who do not feel sexually gratified are, in fact, actively encouraged to seek treatment in order to achieve a ‘normal’ condition of heterosexuality, that excludes dissatisfaction, lack of interest in sex or inability to perform a proper coitus as dysfunctional and pathological (Marshall, 2002; Jackson, Scott, 2010). Along with this inflation of the public's expectations for sexual performance, health professionals are shaped like the "experts" in sexuality (Tiefer, 2007). As noted by Furedi (2006: 18): “the term 'sexual health' indicates that the conduct of intimate life has also become dominated by the medical [and psychological] imperative”. Medical and psychological authorities have then become the culturally approved leading gatekeepers of sexual knowledge and advice. Hence, their professional reach can be seen as determined by the “process of negotiation and conflict with other parties and social forces, for the control of the source of knowledge and professional services market” (Tousijn, 2000: 202). In this sense, the mechanisms which underpin the discovery and the development of a diagnosis and its treatment, are firmly grounded in the socio-cultural context that provides the backdrop for a diagnostic label to flourish and also in the complex web of interactions among lay people, professionals, institutions and stakeholders involved in these processes. This process of an ongoing coproduction among diagnoses, treatments, professional jurisdictions and embodied subjectivities is particularly evident in the male sexual health field. Evidence of these mechanisms can be, for instance, found in the hybrid and negotiated features (Anspach, 2011) of the actual diagnostic and therapeutic management of the main male sexual problems, namely erectile dysfunction (ED) and premature ejaculation (PE). These conditions can be be seen at an intersection where different contending specialties, such as the professions of andrologists and psycho-sexologists, both collaborate and compete to obtain a well- established role within the (male) sexual wellness field. Methodologically the work employs qualitative methods: analysis of scientific journals, text-books and awareness campaigns and 44 in-depth interviews with medical and psychological experts. The use of diagnostic and therapeutic repertoires as heuristic tools allows to highlight differences and similarities among diverse healing approaches which are actively involved in the social construction of masculinity. Specific attention is drawn to the role of pharmaceuticals designed for these male sexual problems, problematizing how (and to what extent) dealing with a range of supposedly “quick-fix” pharmaceutical devices, more or less effective in their promise to restore an adequate level of masculinity, can represent both an advantage and a constraint in their concrete management of male sexual dysfunction. In particular, the advent of the oral drugs for the treatment of impotence seems to have marked a deep watershed forcing the experts to employ new strategies to redefine their jurisdiction.
STEFANIZZI, SONIA
TOGNETTI, MARA GRAZIELLA
medicalizzazione,; diagnosi,; maschilità,; Viagra,; farmacologizzazione
medicalization,; diagnosis,; masculinity,; Viagra,; farmacologizzazione
SPS/07 - SOCIOLOGIA GENERALE
Italian
21-apr-2017
SOCIOLOGIA APPLICATA E METODOLOGIA DELLA RICERCA SOCIALE - 92R
29
2015/2016
open
(2017). La maschilità da curare. Dinamiche di costruzione di repertori diagnostico-terapeutici.. (Tesi di dottorato, Università degli Studi di Milano-Bicocca, 2017).
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10281/158364
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