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 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". Since medicalization is the social process through which a condition becomes a medical disease in need of treatment, medicalization may be viewed as a benefit to human society. According to this view, the identification of a condition as a disease will lead to the treatment of certain symptoms and conditions, which will improve overall quality of life.

History

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.[1] The term medicalization entered the sociology literature in the 1970s in the works of Irving Zola, Peter Conrad and Thomas Szasz, among others. According to Eric Cassell's book, The Nature of Suffering and the Goals of Medicine (2004), the expansion of medical social control is being justified as a means of explaining deviance.[2] 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 article "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).[3] 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[4] examined the power and prestige of the medical profession, including the use of terminology to mystify and of professional rules to exclude or subordinate others. Tiago Correia (2017)[5] offers an alternative perspective on medicalization. He argues that medicalization needs to be detached from biomedicine to overcome much of the criticism it has faced, and to protect its value in contemporary sociological debates. Building on Gadamer's hermeneutical view of medicine, he focuses on medicine's common traits, regardless of empirical differences in both time and space. Medicalization and social control are viewed as distinct analytical dimensions that in practice may or may not overlap. Correia contends that the idea of "making things medical" needs to include all forms of medical knowledge in a global society, not simply those forms linked to the established (bio)medical professions. Looking at "knowledge", beyond the confines of professional boundaries, may help us understand the multiplicity of ways in which medicalization can exist in different times and societies, and allow contemporary societies to avoid such pitfalls as "demedicalization" (through a turn towards complementary and alternative medicine) on the one hand, or the over-rapid and unregulated adoption of biomedical medicine in non-western societies on the other. The challenge is to determine what medical knowledge is present, and how it is being used to medicalize behaviors and symptoms.

Areas

Psychiatry

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).[6] Benjamin Rush, the father of American psychiatry, claimed that Black people had black skin because they were ill with hereditary leprosy. Consequently, he considered vitiligo as a "spontaneous cure".[7] 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.[8]: 70  As scholars have long argued, governmental and medical institutions code menaces to authority as mental diseases during political disturbances.[9]: 14  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".[10]: 515 

Labeling theory

Further information: Labeling theory

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 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.[11]

Healthism

Public health campaigns have been criticized as a form of "healthism", which is moralistic in nature rather than primarily focused on health. Medical doctors Petr Shkrabanek and James McCormick wrote a series of publications on this topic in the late 1980s and early 1990s criticizing the UK's Health of The Nation campaign. These publications exposed abuse of epidemiology and statistics by public health authorities and organizations to support lifestyle interventions and screening programs.[12]: 85 [13]: 7  Inculcating a fear of ill-health and a strong notion of individual responsibility has been derided as "health fascism" by some scholars as it objectifies the individual without considering emotional or social factors.[14]: 8 [13]: 7 [15]: 81 

Professionals, patients, corporations and society

File:Relación Médico Paciente.png
Conversation between doctor and patient

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"[16] or "Sex, drugs, and marketing"[17] 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.[18] A series of publications by Mens Sana Monographs have focused on medicine as a corporate capitalist enterprise.[19][20][21] Scholars argue that in the late 20th century transformation within the health sector in the US altered the relationship between people in the healthcare sector.[22]: 497  This has been attributed to the commodification of healthcare and the role of parties other than doctors such as insurance companies, the pharmaceutical industry, and the government, referred to collectively as countervailing powers.[22]: 499  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. Additionally, there is a widespread concern regarding the extent of the pharmaceutical marketing direct to doctors and other healthcare professionals. Examples of this direct marketing are visits by salespeople, 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. In response to theory based on medicalisation being insufficient to explain social processes, some scholars have developed a concept of biomedicalization which argues that technical and scientific interventions are transforming medicine. One aspect is pharmaceuticalization, the influence of the use of pharmaceutical drugs rather than other interventions. Other components are computerization of parts of healthcare such as public health, the creation of a "biopolitical economy" of private research outside of state, the perception of health as a moral obligation.[23] Medicalization has brought health issues to the fore, so people think more and more about things in terms of health and act to promote health. When it comes to health issues, medicine is not the only provider of answers, but there have always been alternatives and competitors. At the same time as medicalization, "paramedicalization" has strengthened: also many treatments for which there is no medical basis, at least for now, are popular and commercially successful.[24]

See also

References

  1. ↑ White, Kevin (2002). An introduction to the sociology of health and illness. SAGE. p. 42. ISBN 0-7619-6400-2.
  2. ↑ Cassell, Eric J. (2004). The nature of suffering and the goals of medicine (2nd ed.). New York: Oxford University Press. ISBN 9780195156164. OCLC 173843216.
  3. ↑ Conrad P (October 1975). "The discovery of hyperkinesis: notes on the medicalization of deviant behavior". Soc Probl. 23 (1): 12–21. doi:10.2307/799624. JSTOR 799624. PMID 11662312.
  4. ↑ Helman, Cecil (2007). Culture, Health and Illness. London: Arnold. ISBN 9780340914502.
  5. ↑ Correia, Tiago (2017). "Revisiting Medicalization: A Critique of the Assumptions of What Counts As Medical Knowledge" (PDF). Front. Sociol. 2 (14). doi:10.3389/fsoc.2017.00014.
  6. ↑ Kirk, S. A.; Gomory, T.; Cohen, D. (2013). Mad Science: Psychiatric Coercion, Diagnosis, and Drugs. Transaction Publishers. p. 185.
  7. ↑ Thomas Szasz (1970), The Manufacture of Madness, Syracuse University Press, pp. 153–170
  8. ↑ Sapouna, Lydia; Herrmann, Peter (2006). Knowledge in Mental Health: Reclaiming the Social. Hauppauge: Nova Publishers. p. 70. ISBN 1-59454-812-9.
  9. ↑ Metzl, Jonathan (2010). The Protest Psychosis: How Schizophrenia Became a Black Disease. Beacon Press. p. 14. ISBN 978-0-8070-8592-9.
  10. ↑ Szasz, Thomas (Spring 2001). "The Therapeutic State: The Tyranny of Pharmacracy" (PDF). The Independent Review. V (4): 485–521. ISSN 1086-1653. Retrieved 20 January 2012.
  11. ↑ Moynihan, Ray; Heath, Iona; Henry, David (13 April 2002). "Selling sickness: the pharmaceutical industry and disease mongering". BMJ. 324 (7342): 886–891. doi:10.1136/bmj.324.7342.886. PMC 1122833. PMID 11950740.
  12. ↑ Fitzpatrick, Michael (2002-01-04). The Tyranny of Health: Doctors and the Regulation of Lifestyle. Routledge. ISBN 978-1-134-56346-3.
  13. ↑ 13.0 13.1 Fiona, Sim; Martin, McKee (2011-09-01). Issues In Public Health. McGraw-Hill Education (UK). ISBN 978-0-335-24422-5.
  14. ↑ Fitzpatrick, Katie; Tinning, Richard (2014-02-05). Health Education: Critical perspectives. Routledge. ISBN 978-1-135-07214-8.
  15. ↑ Zembylas, Michalinos (2021-05-06). Affect and the Rise of Right-Wing Populism: Pedagogies for the Renewal of Democratic Education. Cambridge University Press. ISBN 978-1-108-83840-5.
  16. ↑ Moynihan, Ray (2003-01-04). "The making of a disease: female sexual dysfunction". BMJ: British Medical Journal. 326 (7379): 45–47. doi:10.1136/bmj.326.7379.45. PMC 1124933. PMID 12511464.
  17. ↑ Mason, Diana J. (2003). "Editorial: Sex, Drugs, and Marketing". The American Journal of Nursing. 103 (6). Lippincott Williams & Wilkins: 7. doi:10.1097/00000446-200306000-00001. ISSN 1538-7488. JSTOR 29745103. PMID 12802146. Retrieved 2022-03-10.
  18. ↑ Filc D (September 2004). "The medical text: between biomedicine and hegemony". Soc Sci Med. 59 (6): 1275–85. doi:10.1016/j.socscimed.2004.01.003. PMID 15210098.
  19. ↑ 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
  20. ↑ Ajai R Singh, Shakuntala A Singh, 2005, "The connection between academia and industry", Mens Sana Monographs, 3(1), p5-35
  21. ↑ Ajai R Singh, Shakuntala A Singh, 2005, "Public welfare agenda or corporate research agenda?", Mens Sana Monographs, 3(1), p41-80.
  22. ↑ 22.0 22.1 The Wiley Blackwell companion to medical sociology. William C. Cockerham. Hoboken, NJ. 2021. ISBN 978-1-119-63380-8. OCLC 1198989810.{{cite book}}: CS1 maint: location missing publisher (link) CS1 maint: others (link)
  23. ↑ Clarke, Adele E. (2014-02-21), "Biomedicalization", in Cockerham, William C; Dingwall, Robert; Quah, Stella (eds.), The Wiley Blackwell Encyclopedia of Health, Illness, Behavior, and Society, Chichester, UK: John Wiley & Sons, Ltd, pp. 137–142, doi:10.1002/9781118410868.wbehibs083, ISBN 978-1-118-41086-8, retrieved 2022-09-23
  24. ↑ Surhone, Lambert M; Tennoe, Mariam T; Henssonow, Susan F, eds. (2010). Paramedicalization. Tallinn: VLC Publishing. ISBN 978-613-3-08893-1.

Further reading

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