Medicalization

Medicalization is the process by which human conditions and problems come to be defined and treated as medical conditions, and thus become the subject of medical study, diagnosis, prevention, or treatment. Medicalization can be driven by new evidence or hypotheses about conditions; by changing social attitudes or economic considerations; or by the development of new medications or treatments.

Medicalization is studied from a sociologic perspective in terms of the role and power of professionals, patients, and corporations, and also for its implications for ordinary people whose self-identity and life decisions may depend on the prevailing concepts of health and illness. Once a condition is classified as medical, a medical model of disability tends to be used in place of a social model. Medicalization may also be termed "pathologization" or (pejoratively) "disease mongering".

Development of the concept

The concept of medicalization was devised by sociologists to explain how medical knowledge is applied to behaviors which are not self-evidently medical or biological. The term medicalization entered the sociology literature in the 1970s in the works of Irving Zola, Peter Conrad and Thomas Szasz, among others. These sociologists viewed medicalization as a form of social control in which medical authority expanded into domains of everyday existence, and they rejected medicalization in the name of liberation. This critique was embodied in 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 might now call ADHD). Nevertheless, opium was used to pacify children in ancient Egypt before 2000 BC.

These sociologists did not believe medicalization to be a new phenomenon, arguing that medical authorities had always been concerned with social behavior and traditionally functioned as agents of social control (Foucault, 1965; Szasz,1970; Rosen). However, these authors took the view that increasingly sophisticated technology had extended the potential reach of medicalization as a form of social control, especially in terms of "psychotechnology" (Chorover,1973).

In the 1975 book Limits to medicine: Medical nemesis (1975), Ivan Illich put forth one of the earliest uses of the term "medicalization". Illich, a philosopher, argued that the medical profession harms people through iatrogenesis, a process in which illness and social problems increase due to medical intervention. Illich saw iatrogenesis occurring on three levels: the clinical, involving serious side effects worse than the original condition; the social, whereby the general public is made docile and reliant on the medical profession to cope with life in their society; and the structural, whereby the idea of aging and dying as medical illnesses effectively "medicalized" human life and left individuals and societies less able to deal with these "natural" processes.

The concept of medicalization dovetailed with some aspects of the 1970s feminist movement. Critics such as Ehrenreich and English (1978) argued that women's bodies were being medicalized by the predominantly male medical profession. Menstruation and pregnancy had come to be seen as medical problems requiring interventions such as hysterectomies.

Marxists such as Vicente Navarro (1980) linked medicalization to an oppressive capitalist society. They argued that medicine disguised the underlying causes of disease, such as social inequality and poverty, and instead presented health as an individual issue. Others examined the power and prestige of the medical profession, including use of terminology to mystify and of professional rules to exclude or subordinate others.

Professionals, patients, corporations and society

Several decades on the definition of medicalization is 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 medicalization. Titles such as "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, others reject as implausible any suggestion that society rejects drugs or drug companies, and highlight that the same drugs that are allegedly used to 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 in many quarters has come to be on "overmedicalization" rather than "medicalization" in itself.

Others, however, argue that in practice the process of medicalization tends to strip subjects of their social context, so they come to be understood in terms of the prevailing biomedical ideology, resulting in a disregard for overarching social causes such as unequal distribution of power and resources. A series of publications by Mens Sana Monographs have focused on medicine as a corporate capitalist enterprise.

Conversation between doctor and patient/consumer.

The physician's role in this present-day notion of medicalization is similarly complex. On the one hand, the doctor remains an authority figure who prescribes pharmaceuticals to patients. However, in some countries such as the US, ubiquitous direct-to-consumer advertising encourages 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. And there is also widespread concern regarding the extent of the pharmaceutical marketing direct to doctors and other healthcare professionals, for example through visits by sales people, funding of journals, training courses or conferences, incentives for prescribing, and the routine provision of "information" written by the pharmaceutical company.

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.

The antithesis of medicalization is the process of paramedicalization, where human conditions come under the attention of alternative medicine, traditional medicine or any of numerous non-medical health approaches. Medicalization and paramedicalization can sometimes be contradictory and conflicting, but they also feed each other: they both ensure that questions of health and illness stay in sharp focus in defining human conditions and problems.

Areas

A 2002 editorial in the British Medical Journal warned of inappropriate medicalization leading to disease mongering, where the boundaries of the definition of illnesses are expanded to include personal problems as medical problems or risks of diseases are emphasized to broaden the market for medications. The authors noted:

Inappropriate medicalisation carries the dangers of the unnecessary labelling, poor treatment decisions, iatrogenic illness, and economic waste, as well as the opportunity costs that result when resources are diverted away from treating or preventing more serious disease. At a deeper level it may help to feed unhealthy obsessions with health, obscure or mystify sociological or political explanations for health problems, and focus undue attention on pharmacological, individualised, or privatised solutions".

For many years, marginalized psychiatrists (such as Peter Breggin, Paula Caplan, Thomas Szasz) and outside critics (such as Stuart A. Kirk) have "been accusing psychiatry of engaging in the systematic medicalization of normality". More recently these concerns have come from insiders who have worked for and promoted the American Psychiatric Association (e.g., Robert Spitzer, Allen Frances).

Benjamin Rush, the father of American psychiatry, claimed that Negroes had black skin because they were ill with hereditary leprosy; and he proposed to use their illness as a justification for their social control. Consequently, he considered vitiligo as a "spontaneous cure".

According to Franco Basaglia and his followers, whose approach pointed out the role of psychiatric institutions in the control and medicalization of deviant behaviors and social problems, psychiatry is used as the provider of scientific support for social control to the existing establishment, and the ensuing standards of deviance and normality brought about repressive views of discrete social groups. As scholars have long argued, governmental and medical institutions code menaces to authority as mental diseases during political disturbances.

The HIV/AIDS pandemic allegedly caused from the 1980s a "profound re-medicalization of sexuality". The diagnosis of Premenstrual dysphoric disorder has caused some controversy, and psychologist Peggy Kleinplatz has criticized the diagnosis as medicalization of normal human behavior, that occurred while fluoxetine (also known as Prozac) was being repackaged as a PMDD therapy under the trade named Sarafem. Although it has received less attention, it is claimed that masculinity has also faced medicalization, being deemed damaging to health and requiring regulation or enhancement through drugs, technologies or therapy.

According to Kittrie, a number of phenomena considered "deviant", such as alcoholism, drug addiction, homosexuality, prostitution, pedophilia, and masturbation ("self-abuse"), were originally considered as moral, then legal, and now medical problems. Innumerable other conditions such as obesity, smoking cigarettes, draft malingering, bachelorhood, divorce, unwanted pregnancy, insurance fraud, kleptomania, and grief, have been declared a disease by medical and psychiatric authorities who hold impeccable institutional credentials. Due to these perceptions, peculiar deviants were subjected to moral, then legal, and now medical modes of social control. Similarly, Conrad and Schneider concluded their review of the medicalization of deviance by supposing that three major paradigms may be identified that have reigned over deviance designations in different historical periods: deviance as sin; deviance as crime; and deviance as sickness.

According to Mike Fitzpatrick, resistance to medicalization was a common theme of the gay liberation, anti-psychiatry, and feminist movements of the 1970s, but now there is actually no resistance to the advance of government intrusion in lifestyle if it is thought to be justified in terms of public health. Moreover, the pressure for medicalization also comes from society itself. Feminists, who once opposed state intervention as oppressive and patriarchal, now demand more coercive and intrusive measures to deal with child abuse and domestic violence. According to Thomas Szasz, "the therapeutic state swallows up everything human on the seemingly rational ground that nothing falls outside the province of health and medicine, just as the theological state had swallowed up everything human on the perfectly rational ground that nothing falls outside the province of God and religion".

See also

• Iatrogenesis
• Interventionism (medicine)
• Medical model
• Sociology of health and illness

Further reading

• Peter Conrad, The Medicalization of Society: On the Transformation of Human Conditions into Medical Disorders (Johns 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)
• Jamoulle M. Quaternary prevention, an answer of family doctors to overmedicalization. International Journal of Health Policy and Management. 4-Feb-2015; 4:1–4.