Medicalization

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Medicalization is the process by which human conditions and problems come to be defined and treated as medical conditions and problems, and thus come under the authority of doctors and other health professionals to study, diagnose, prevent or treat. The process of medicalization can be driven by new evidence or theories about conditions, or by developments in social attitudes or economic considerations, or by the development of new purported treatments. Medicalization is often claimed to bring benefits, but also costs, which may not always be clear. Medicalization is studied in terms of the role and power of professions, 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 classed as medical, a medical model of disability tends to be used rather than a social model. Medicalization may also be termed pathologization (from pathology), or in some cases disease mongering.

Development of the concept

The term medicalization enter publications in the 1970s, for example in the works of figures such as Irving Zola, Peter Conrad and Thomas Szasz. They argued that the expansion of medical authority into domains of everyday existence was promoted by doctors and was a force of social control that was to be rejected in the name of liberation. 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 might now call ADHD).

This function of medical institutions and public health was not thought to be new, as they have always been concerned with social behavior and traditionally functioned as agents of social control (Foucault, 1965; Szasz,1970; Rosen). It was claimed, however, that increasingly sophisticated medical technology had extended the potential of this type of social control, especially in terms of "psychotechnology" (Chorover,1973) and a variety of medical and quasi-medical treatments or procedures.

Ivan Illich in "Limits to medicine: Medical nemesis" (1975) influentially made one of the earliest uses of the term "medicalization". Illich, a philosopher, argued that the medical profession actually harms people in a process known as iatrogenesis, where there is an increase in illness and social problems as a result of medical intervention. Illich saw this occurring on three levels: the clinical, which involves serious side-effects that are often worse than the original condition; the social, whereby the general public is made docile and reliant on the medical profession to help them cope with their life in their society; or the structural, whereby 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.

Critics such as Ehrenreich and English (1978) argued that women's bodies were being medicalized. Menstruation and pregnancy had come to be seen as medical problems requiring interventions such as hysterectomies.

Marxists such as Vicente Navarro (1980), and others, linked medicalization to an oppressive capitalist society. They argued that medicine can disguise the underlying causes of disease, such as social inequality and poverty, and instead people see health as an individual problem. 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 reject 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 "over-medicalization" 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 over-arching social causes such as unequal distribution of power and resources.^[1] A series of publications by Mens Sana Monographs have focused on medicine as a corporate capitalist enterprise ^{[2] [3] [4]}.

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 of medicalization

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 disorders) is a primary area of alleged medicalization. For instance, the current (DSM-IV) version, lists impotence, premature ejaculation, jet lag, and caffeine intoxication. One argument is that medicalization of such conditions can give a veneer of medical importance to otherwise vague and unscientific conditions, for example the most commonly diagnosed "personality disorder" is "309.9 Personality disorder not otherwise specified". 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 become more acceptable and been de-medicalized (e.g., homosexuality, masturbation, and particular theories such as Samuel Cartwright's infamous drapetomania - the madness of slaves who try to flee captivity). Medicalization in this area, whether through psychiatry or more specifically biopsychiatry, has been most consistently and radically challenged by the antipsychiatry movement.^[5]

The HIV/AIDS pandemic allegedly caused from the 1980s a "profound re-medicalization of sexuality".^[6][7] 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.^[8] 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.^[9]

In 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. Subjects of debate included, 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 Caesarean 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 an appropriate response to debilitating neurological imbalances, or medicalization of "normal sadness", or somehow pathologizes a natural and rational reaction to the modern world.
• and whether menopause, andropause, and aging as a whole should be considered physiological malfunctions or normal life processes

See also

• Classification of Pharmaco-Therapeutic Referrals
• Interventionism (medicine)
• Inverse benefit law
• Medical anthropology
• Medical sociology
• Overdiagnosis
• Psychobabble
• Psychopharmacology
• Quaternary prevention
• Schooliosis
• Sociology of health and illness

References

1. ^ Soc Sci Med. 2004 Sep;59(6):1275-85. The medical text: between biomedicine and hegemony. Filc D. PMID 15210098
2. ^ Ajai R Singh, Shakuntala A Singh, 2005, "Medicine as a corporate enterprise, patient welfare centered profession, or patient welfare centered professional enterprise?" Mens Sana Monographs, 3(2), p19-51
3. ^ Ajai R Singh, Shakuntala A Singh, 2005, "The connection between academia and industry", Mens Sana Monographs, 3(1), p5-35
4. ^ Ajai R Singh, Shakuntala A Singh, 2005, "Public welfare agenda or corporate research agenda?", Mens Sana Monographs, 3(1), p41-80.
5. ^ Antipsychiatry: Meeting the challenge (2005)
6. ^ Aggleton, Peter; Parker, Richard Bordeaux; Barbosa, Regina Maria (2000). Framing the sexual subject: the politics of gender, sexuality, and power. Berkeley: University of California Press. ISBN 0-520-21838-8.  p.3
7. ^ Carole S. Vance "Anthropology Rediscovers Sexuality: A Theoretical Comment." Social Science and Medicine 33 (8) 875-884 1991
8. ^ Offman A, Kleinplatz PJ (2004). Does PMDD Belong in the DSM? Challenging the Medicalization of Women's Bodies. The Canadian Journal of Human Sexuality, Vol. 13
9. ^ Medicalized masculinities (2006) by Dana Rosenfeld, Christopher A. Faircloth

Further reading

• 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 (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)
• Ray Moynihan, "Selling sickness: the pharmaceutical industry and disease mongering" (British Medical Journal, 2002)
• Tsipy Ivry and Elly Teman, "Expectant Israeli Fathers and the Medicalized Pregnancy", (Culture, Medicine and Psychiatry, 2008).
• Elly Teman, "The Medicalization of Nature in the Artificial Body: Surrogate Motherhood in Israel", Medical Anthropology Quarterly, 2003.

External links

• Public site concerning medicalization by Markku Myllykangas and Raimo Tuomainen, Kuopio, Finland