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Rojas
Starting in the late 1970s and increasingly thereafter, state funding encouraged a
strong, system-based response to domestic violence. This funding brought together
the criminal justice system, hospitals, and social service agencies to intervene in
domestic violence. Prior to this, some antiviolence laws were on the books, but
there was minimal prosecution and limited law enforcement involvement. As the
state moved in, the real need for survivor safety came increasingly to be translated
into a “need” for prisons and for social services. This logic supported the strate-
gic expansion of the prison industrial complex (PIC), and domestic violence came
to be seen as a crime. It also supported the development of the nonprofit indus-
trial complex, as nonprofit agencies were set up and funded by the state to pro-
vide counseling and shelter services, with scant funding for social change work. As
the criminalization and non-profitization of domestic violence were underway, the
medicalization of domestic violence also ensued.
On Medicalization
When institutionalized, “mainstream” or western medicine reconstitutes social
problems as “diseases” or individual pathologies in need of medical intervention,
we can call this medicalization.1 Medical intervention is increasingly deemed
indispensable in eliminating the epidemic of domestic violence, and the “medical
industrial complex” (MIC) is beginning to shape how we think about domestic
violence, as well as how we prevent—or intervene and treat—the “disease.”2 Like
criminalization, medicalization represents a deep threat to the movement, because
it uproots the conceptualization of domestic violence as a social problem. Instead,
it replaces the ideology and structures of social movements with the ideology and
structures of (western) medicine, subsuming grassroots to state and capital inter-
ests.
This is particularly dangerous to women of color and our communities
because we have suffered a long and continuing history of (western) medical vio-
The Medicalization of Domestic Violence 181
lence. In fact, the institution of (western) medicine has served the interests of
colonial, slavery, capitalist and racist systems by excluding us from needed care,
and has administered death, disease, and injury. The medicalization of domestic
violence is also structured to be interdependent with the criminalization and non-
profitization of domestic violence. For example, as in the opening story, a stop at
the hospital can lead to criminal charges—sometimes without survivor consent—
which potentially enlists processes of incarceration, detention, and deportation.
The object of medical inquiry (disease/illness) is “not necessarily inherent in
any behavior or condition, but [it is] constructed.”3 Just as we call into question
what, when, and why something is considered a crime, we can also question what,
when, and why something becomes a medical issue. Thus, when we reflect and
interrogate medicalization, we can critically consider the ways medicine, as a tool
of social control, has been extended to more and more aspects of our lives. This
extension bears the interests of the MIC—the relationship between medicine,
capital, and the state.4 The structured goals of the medical industrial complex
are to heighten profits, legitimate the state, and maintain the dominance of the
western medical model, which, in turn, perpetuates racism, classism, and het-
erosexism. The institution of medicine is organized and structured to reflect and
reproduce society’s class, racial, and gendered hierarchies, and as it mirrors and
purports injustice, it also produces ideology that legitimates it.
For example, the racist and capitalist class structures in medicine are trans-
parent in the maintenance of an elite corporate/upper class which makes health
policies and reaps the financial benefits of the “business,” while an exploited class
is made responsible for low-wage dirty work, including janitorial, nursing assis-
tance, and administrative work. Not surprisingly, class lines in medicine are also
racial lines, and people of color are overrepresented in the exploited groups. When
we examine the phenomena of medicalization, we see systemic legitimation, or
hegemony maintenance, and the efforts of a particular institution (medicine) to
maintaining inequality.5
Furthermore, the medical gaze transposes a disease model that sets out to
deflect attention away from social injustices, while highlighting individual pathol-
ogy.6 Social phenomena come to be understood as problems that western medi-
cine can solve; some call this the MIC’s habit of turning “badness into sickness.”7
Not coincidentally, medicalization expands during times of social protest. For
example, state expenditures on public health usually rise during periods of social
protest (as they did in the late 1960s and 1970s), while cutbacks in public health
services were instituted in the early 1980’s, following a decline in social protest by
low-income communities.8
Understanding medicalization can help us map out—or prevent—the coop-
tation of a social movement. So as women of color working against violence, it is
imperative that we recognize that reliance on the medical industrial complex is
deeply problematic, as its unjust institutional structure, as well as its racist, clas-
sist, and sexist interests, always come along with the package. What, then, does the
medicalization of domestic violence mean for our safety as women of color, and
what does it imply for the movement’s goal of eliminating domestic violence?
182 Color of Violence
posing western values and colonial racist epistemologies and figures (e.g., the all-
knowing patriarchal doctor). Thus, the power of healing is displaced from women
and indigenous communities.15 bell hooks reminds us, “conscious of race, sex,
and class issues, I wondered how I would be treated in this white doctor’s office.
Through it all, he talked to me as if I were a child …”16
Medical violence is deployed from etiology (diagnosis, naming of disease and
establishment of cause), to prevention (or lack thereof), treatment (“care” poten-
tially injurious or unavailable), and research (treating people of color as guinea
pigs).17 And as discussed earlier, the MIC buttresses racist and colonial state needs
by surveilling and reporting on communities, regulating human bodies, and by
further dominating the colonized by imposing docility.18
The irony is that colonial invasion and war often create “needs” for medical
intervention, as was the case with one of the most lethal forms of colonial violence
throughout the Americas: the intentional spread of infectious diseases such as
tuberculosis, measles and smallpox to indigenous communities.19 Once this need
is bolstered, additional forms of medical violence—such as active exclusion and
withholding of treatment—emerge, and become tools of social control; the MIC
determines who is treated, who lives, who dies. Even if treatment is provided, vio-
lence persists as the delivery of medical “care” is still rife with racism, classism, and
sexism, as well as state and colonial interests and structures.20
For example, historically the “sick role” has been assigned to marginalized
communities in the US, as it implies “deviance” in need of medical intervention.
Through medicine, colonial racist archetypes of the “diseased and uncivilized”
other were legitimated, and the “other” was created.21 Medicine’s professional and
eurocentric shroud confirms and grants the authority to define sickness, name the
sick, identify the “healthy,” and prescribe what is biologically normal and what is
not, thereby discerning between what should be called “natural,” and what should
be called “unnatural.”22
“Drapetomania” stands among the first medical diagnoses in the United
States. Samuel Cartwright, a physician in New Orleans defined it as “the desire
for a slave to run away.”23 Among the causes listed were laziness and poor intel-
lectual capabilities.24 Only slaves were able to contract this “disease,” much like
only slaves were able to violate the first criminal laws enacted in this country.25
In the New Orleans Medical and Surgical Journal, Dr. Cartwright argued that
the tendency of slaves to run away was a treatable medical disorder, believing
that with “proper medical advice, strictly followed, the troublesome practice
that many Negroes have of running away could almost entirely be prevented.”
Whipping was prescribed as the most effective treatment of the disorder and
amputation of the toes was prescribed for cases that failed to respond to whip-
ping.26 This is an early example of the violence of western medical thought and
practice. First, an ideological marker of disease is inflicted on a resistant slave’s
plight to recapture his/her liberty and humanity; then, an ideological shift dis-
places consideration of an unjust social order, replacing it with a medical diag-
nosis present in an individual and curable under the jurisdiction of medical
purview. Finally, as a result, slavery is legitimized and buttressed by medicine.
The Medicalization of Domestic Violence 185
Given this history, it’s not surprising that people of color—especially poor people
of color—often have served as the guinea pigs of the Medical Industrial Complex,
suffering poor health and death as consequences. Among the most flagrant his-
toric examples of the MIC’s use of poor people of color as guinea pigs is the Tuske-
gee syphilis experiment. In 1932 government doctors began a study on the effects
of the illness. Their project deemed “expendable” the bodies of southern Black
sharecroppers by withholding treatment and lying about treatment; for exam-
ple, excruciatingly painful spinal taps were performed under the guise of treat-
ment. While the medical community failed to note any wrongdoing, the research
project continued for many years.27 Well into World War II, the lead scientific
investigators even secured government exceptions from military recruitment for
the research subjects, because the military provided treatment for syphilis. As a
result, nearly one hundred men died and many more lived with chronic and seri-
ous health complications.
Indeed “the burden of scientific investigation has rested on those that are
socially and therefore medically disenfranchised.”28 In Puerto Rico in the 1960’s,
birth control pills three to four times the hormone dosages of today’s birth control
pills were tested on women without their consent. Many were killed and injured
while being used as guinea pigs. Eugenecist Margaret Sanger, the mother of the
(western interventionist) birth control movement and founder of Planned Parent-
hood, went to Puerto Rico to support “administering physicians.”
Sterilization
Attacks on our sexual and reproductive systems are among the most pervasive types
of medical violence against women of color. Medicine furthers colonial attacks
through eugenics and population control. The eugenics movement set out to repro-
duce “the superior stock of the nation.” In the early 20th century, Margaret Sanger
argued that birth control would be an effective way to reduce the size of “unde-
sirable” populations who would become a hindrance to the development of the
idealized white supremacist nation-state.29 In her essay “Better Dead than Preg-
nant,” Andrea Smith notes, “women of color become particularly dangerous to the
world order as they have the ability to reproduce the next generations of commu-
nities of color.”30 In the United States, sterilization has been practiced on Japanese
women while they were detained in internment camps in WWII, Mexican immi-
grants and Chicanas, Native and Puerto Rican women. In her book, Birthing the
Nation: Strategies of Palestinian Women in Israel, Rhoda Ana Khanaaneh argues
that “female, nonwhite and poor bodies are seen as population growth vessels that
must be stopped.”31 In Killing the Black Body, Dorothy Roberts wrote that “regulat-
ing Black women’s reproductive decisions has been a central aspect of racial oppres-
sion in America.”
From the 1930s to the 1960s, close to one half of Puerto Rican women of
childbearing age were sterilized without their informed consent.32 The procedure
came to be called simply “la operación” (“the operation”) because it was so com-
mon. Population control rhetoric claimed that the island population was “explod-
ing” while at the same time multinational corporations had relocated the garment
industry to Puerto Rico, which heightened their need for female “unattached”
186 Color of Violence
the lethality of domestic violence.46 Mandatory reporting policies and the medi-
calization of domestic violence heightens the grave danger immigrant survivors
already face.47
Conclusion
Medicalization transforms the survivor into a patient, presenting with an injury/
medical need which can be addressed by the presiding (and often paternalistic)
physician, law enforcement and the state. The medical response does not address
domestic violence as a consequence of structured inequalities and social processes:
“The narrowing of the analysis of sexual crimes to evidentiary, medical and legal
aspects strips away the context of oppression.” 48 Medical interventions in domestic
violence are constructed as acts of “sensitivity” provided to survivors, and related
to improving service delivery through identification and screening procedures.
The focus is not on injustice and inequality. With medicalization, the oppositional
thinking of social movements is swallowed up and a prescription is rendered as
social change work is quietly sent into oblivion.
Medicalization is a tool used by the MIC to heighten profits, legitimate the
state, maintain medical dominance, reproduce social inequalities, and co-opt
social movements (by expanding at times of social protest.) The lived experiences
of women of color and our communities can dislocate the assumption that medi-
cine will heal.49 Frantz Fanon relates the example of a “non-compliant”Algerian
patient who would not divulge any information about his health.50 He knew
he faced not only a doctor but the colonizer, so he resisted. We all know the
“ordeal” it is to go to the doctor’s. We come to expect racist and classist treat-
ment. Acts of refusal or resistance to medical treatment are acts against medi-
cal violence. Perhaps sister Audre, in her struggle with cancer, was invoking
our survival and resistaince of medical violence when she said that as women of
color, to take care of ourselves and our health is an act of political warfare.
Lastly, let’s challenge the calls for a “system-based” response to domes-
tic violence; it is this very call that gave heed and runway to criminalization
and medicalization. Let’s call out and stop relying on violent institutions to
attempt to solve violence, i.e. the Medical Industrial Complex, Military Indus-
trial Complex, PIC, etc. Isn’t domestic violence an outgrowth of these very
institutions? Instead, let’s build movements for healing that are accountable
to us and our communities and that don’t reproduce oppressive relations. Let’s
call out the medicalization of domestic violence and re-invigorate a grassroots
movement against domestic violence that doesn’t shy away from asking, or isn’t
paid to forget to ask “what’s it really gon’na take to live lives free of violence?”