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Medicalization
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Medicalization (or medicalisation) is the process by which health or behavior conditions come to be defined and treated as medical issues. The term refers to the process by which certain events or characteristics of everyday life become medical issues, and thus come within the purview of doctors and other health professionals to engage with, study, and treat. The process of medicalization typically involves changes in social attitudes and terminology, and usually accompanies (or is driven by) the availability of treatments.
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Encyclopedia
Medicalization (or medicalisation) is the process by which health or behavior conditions come to be defined and treated as medical issues. The term refers to the process by which certain events or characteristics of everyday life become medical issues, and thus come within the purview of doctors and other health professionals to engage with, study, and treat. The process of medicalization typically involves changes in social attitudes and terminology, and usually accompanies (or is driven by) the availability of treatments. The process has also been negatively referred to as disease mongering. The medicalization of these life experiences has brought with it benefits, but at a price. And those costs, which are not just financial, are not always clear.
Etymology and perception
The term medicalization entered academic and medical publications in the 1970s in the work of Thomas Szaz, Emile Zola, and Peter Conrad. The expansion of medical authority into the domains of everyday existence was promoted by doctors and was therefore a force to be rejected in the name of specific kinds of liberation. Medicalization in this sense was characterized as "social control." This critique was embodied in now-classic works such as Conrad's "The discovery of hyperkinesis: notes on medicalization of deviance," published in 1973 (hyperkinesis was the term then used to describe what we would now call ADHD) and immediately illiciting a round of commentary.
About 30 years on, the definition of medicalization is more complicated, if for no other reason than because the term is so widely used. Many contemporary critics position pharmaceutical companies in the space once held by doctors as the supposed catalysts of social transformation. Titles such as the The making of a disease or Sex, drugs, and marketing critique the pharmaceutical industry for shunting everyday problems into the domain of professional biomedicine. At the same time, to suggest that society simply reject drugs or drug companies in much the same ways some have suggested it "liberate" itself from the medical system is implausible. The same drugs that treat deviances from societal norms also help many people live their lives. Even scholars who critique the societal implications of brand-name drugs generally remain open to these drugs' curative effects — a far cry from earlier calls for a revolution against the biomedical establishment. The emphasis has come to be on "overmedicalization" rather than "medicalization" per se.
The physician's role in this present-day notion of medicalization is similarly complex. On one hand, the doctor remains an authority figure who prescribes pharmaceuticals to patients. Whereas on the other, ubiquitous consumer-directed advertisements instruct patients to ask for particular drugs by name, thereby creating a conversation between consumer and drug company that threatens to cut the doctor out of the loop. The role of patients in this economy has also changed. Once regarded as passive victims of medicalization, patients can now occupy active positions as advocates, consumers, or even agents of change. In many cases, such as Chronic Fatigue Syndrome and Fibromyalgia, patients whose complaints have been given little respect by the medical establishment have advocated with some success for the medicalization of their symptoms into loosely characterized diagnosable conditions.
Growth and evolution
The dramatic growth in the number of categories of mental illness as explained in the various versions of the DSM (diagnostic and statistical manual of mental illness) is a primary example. For instance, the current (DSM-IV) version, lists impotence, premature ejaculation, jet lag, and caffeine intoxication as mental illnesses. Further, a "patina of medical importance" is given to the most commonly diagnosed personality disorder (309.9 Personality Disorder not Otherwise Specified.)
In the process of medicalization, the purview of medicine extends to formerly non-medical areas of life, by identifying formerly non-medical conditions such as social deviance and aging as medical problems. This concept was named by Irving K. Zola. The sociologist Peter Conrad, among others, has written widely about the process of medicalization.
The concept can be defined in several ways. Usually social scientists talk about medicalization considering the status of medicine: doctors control people. In a narrower sense medicalization means that human decisions (both on a personal and a common level) increasingly rest on health consciousness.
The antithesis of medicalization is the process of paramedicalization, where alternative therapies and theories of health, wellness and disease are adopted. Even if medicalization and paramedicalization are contradictory, they also feed each other: they both ensure that the questions of health and illness stay in sharp focus.
As an historical example, the HIV/AIDS pandemic caused since the 1980s a "profound re-medicalization of sexuality".
Many socially unacceptable behaviors have been medicalized and assigned disease terms in the 20th century (e.g. alcoholism, obesity, attention deficit disorder) while some behaviors previously considered medical problems have been de-medicalized (e.g., homosexuality, masturbation, and Samuel Cartwright's infamous dysesthesia aethiopsis or Dysaethesia Aethiopica and drapetomania).
Discussion
In June 2005, an interdisciplinary group of scholars gathered in New York City, USA to discuss the clinical, philosophical, and political implications of medicalization. The group's central question was whether, in the industrialized world, medicalization remains a viable notion in an age dominated by complex and often contradictory interactions between medicine, pharmaceutical companies, and culture at large. Participants represented a variety of disciplines, including psychiatry, sociology, anthropology, history, critical race theory, and gender studies. As such, topics ranged from the economics of medicalization to the creation and perpetuation of medicalized forms of identity and citizenship.
Current subjects of debate include, but are by no means limited to, the following:
- the medicalization of childbirth and pregnancy as indicated by the high rate of intensive interventions (according to the CDC, 1/3 of American births are by Cesearian section)
- the medicalization of race via so-called race-based medicine and racially-targeted pharmaceuticals such as Bidil (aimed at preventing serious cardiovascular outcomes in African-Americans)
- whether treatment of depression is and appropriate response to debilitating neurological imbalances or the medicalization of "normal sadness" or somehow pathologizes a natural and rational reaction to the modern world's detachment from stable traditional value systems
- and whether menopause, andropause, and aging as a whole should be considered physiological malfunctions or normal life processes
Further reading
- Ivan Illich, Limits to medicine: Medical nemesis, the expropriation of health (1975) — The book influentially made one of the earliest uses of the term "medicalization." Illich, a philosopher, argued that the medical establishment posed a "threat to health" through the production of clinical, social, and cultural "iatrogenesis". For Illich, Western medicine's notion of issues of healing, aging, and dying as medical illnesses effectively "medicalized" human life, rendering individuals and societies less able to deal with these "natural" processes. Illich's assessment of professional medicine, and particularly his use of the term medicalization, quickly caught on, as critiques of the expansive categories of illness and health appeared throughout a vast array of professional literatures throughout the 1970s and 1980s. While this book remains a classic discussion of medicalization, some of the concepts presented and specifics discussed have become dated due to changes in society and medicine.
- Peter Conrad and Joseph Schneider, Deviance and Medicalization: From Badness to Sickness (1992)
- Sami Timimi, Pathological Child Psychiatry and the Medicalization of Childhood, Brunner-Routledge, 2002, ISBN 158391216997765.
- Peter Conrad, The Medicalization of Society: On the Transformation of Human Conditions into Medical Disorders (John Hopkins University Press, 2007)
- Allan Horwitz and Jerome Wakefield, The Loss of Sadness: How Psychiatry has Transformed Normal Sadness into Depressive Disorder (Oxford University Press, 2007)
- Christopher Lane, Shyness: How Normal Behavior Became a Sickness (Yale University Press, 2007)
- Ray Moynihan, "Selling sickness: the pharmaceutical industry and disease mongering" (British Medical Journal, 2002)
See also
External links
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