The social construction of illness is a major research perspective in medical sociology. This article traces the roots of this perspective and presents three overarching constructionist findings. First, some illnesses are particularly embedded with cultural meaning-which is not directly derived from the nature of the condition-that shapes how society responds to those afflicted and influences the experience of that illness. Second, all illnesses are socially constructed at the experiential level, based on how individuals come to understand and live with their illness. Third, medical knowledge about illness and disease is not necessarily given by nature but is constructed and developed by claims-makers and interested parties. We address central policy implications of each of these findings and discuss fruitful directions for policyrelevant research in a social constructionist tradition. Social constructionism provides an important counterpoint to medicine's largely deterministic approaches to disease and illness, and it can help us broaden policy deliberations and decisions.

This article illustrates the role electronic support groups play in consumer-driven medicalization. The analysis is based on an observational study of a year in the life of an electronic support group for sufferers of the contested illness fibromyalgia syndrome. The analysis builds on and extends scholarship concerning the growing influence of lay expertise in the context of medical uncertainty by showing how the dominant beliefs and routine practices of this electronic community simultaneously (and paradoxically) challenge the expertise of physicians and encourage the expansion of medicine's jurisdiction. Drawing on their shared embodied expertise, participants confirm the medical character of their problem and its remedy, and they empower each other to search for physicians who will recognize and treat their condition accordingly. Physician compliance is introduced as a useful concept for understanding the relationship between lay expertise, patient-consumer demand, and contemporary (and future) instances of medicalization.

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A central mechanism by which medicalization occurs is through domain expansion, wherein an existing diagnostic definition widens to include cases beyond its original scope. This has been especially commonplace with respect to mental illness diagnoses. In contrast, there are few clear instances of domain contraction. The controversy surrounding the revisions to autism in advance of the publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is thus of considerable importance. Many autism advocates feared the new definition of autism would exclude a significant number of individuals who are already diagnosed. We examine lay claims making to this perceived instance of domain contraction through a content analysis of online reader comments to a high-profile New York Times article reporting on the DSM-5 autism criteria. Our analysis points to an amorphous group of social stakeholders who express a variety of concerns about unabated medicalization. We also identify the stance of diagnostic domain defense, which is an oppositional response by laypeople with a personal connection to a diagnosis to a real or perceived challenge to the definitional boundaries of that diagnosis. Our analysis explicates the dimensions of diagnostic domain defense, which include its grounding in experiential certainty and anguish, and the accrual and deployment of diagnostic resources. We make a case for the utility of this concept for theorizing the relationship between lay claims making, diagnoses, and medicalization. We also make a case for the use of online reader comments as a way to unobtrusively study lay claims making related to pressing social problems in the Internet era.