Medicalization
Encyclopedia
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
Health care provider
A health care provider is an individual or an institution that provides preventive, curative, promotional or rehabilitative health care services in a systematic way to individuals, families or communities....

 to study, diagnose, prevent
Preventive medicine
Preventive medicine or preventive care refers to measures taken to prevent diseases, rather than curing them or treating their symptoms...

 or treat
Therapy
This is a list of types of therapy .* Adventure therapy* Animal-assisted therapy* Aquatic therapy* Aromatherapy* Art and dementia* Art therapy* Authentic Movement* Behavioral therapy* Bibliotherapy* Buteyko Method* Chemotherapy...

. 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
Medical model of disability
The medical model of disability is a sociopolitical model by which illness or disability, being the result of a physical condition, and which is intrinsic to the individual , may reduce the individual's quality of life, and causes clear disadvantages to the individual.It is today specifically...

 tends to be used rather than a social model
Social model of disability
The social model of disability is a reaction to the dominant medical model of disability which in itself is a Cartesian functional analysis of the body as machine to be fixed in order to conform with normative values...

. Medicalization may also be termed pathologization (from pathology
Pathology
Pathology is the precise study and diagnosis of disease. The word pathology is from Ancient Greek , pathos, "feeling, suffering"; and , -logia, "the study of". Pathologization, to pathologize, refers to the process of defining a condition or behavior as pathological, e.g. pathological gambling....

), or in some cases disease mongering
Disease mongering
]Disease mongering is a pejorative term for the practice of widening the diagnostic boundaries of illnesses, and promoting public awareness of such, in order to expand the markets for those who sell and deliver treatments, which may include pharmaceutical companies, physicians, and other...

.

Development of the concept

The concept of medicalization was created by sociologists and is used for explaining how medical knowledge is applied to a series of behaviors, over which medicine exerts control, although those behaviors are not self-evidently medical or biological. The term medicalization enter publications in the 1970s, for example in the works of figures such as Irving Zola
Irving Zola
Irving Kenneth Zola was an internationally-known activist and writer in the fields of medical sociology and disability rights. He was a founding member of the Society of Disability Studies and the first editor of Disability Studies Quarterly...

, Peter Conrad
Peter Conrad (sociologist)
Peter Conrad is an American medical sociologist who has researched and published on numerous topics including ADHD, the medicalization of deviance, the experience of illness, wellness in the workplace, genetics in the news, and biomedical enhancements.-Biography:He has been a member of the faculty...

 and Thomas Szasz
Thomas Szasz
Thomas Stephen Szasz is a psychiatrist and academic. Since 1990 he has been Professor Emeritus of Psychiatry at the State University of New York Health Science Center in Syracuse, New York. He is a well-known social critic of the moral and scientific foundations of psychiatry, and of the social...

. 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
Hyperkinesis
Hyperkinesia, also known as hyperkinesis, refers to an increase in muscular activity that can result in excessive abnormal movements, excessive normal movements, or a combination of both...

 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
Ivan Illich
Ivan Illich was an Austrian philosopher, Roman Catholic priest, and "maverick social critic" of the institutions of contemporary western culture and their effects on the provenance and practice of education, medicine, work, energy use, transportation, and economic development.- Personal life...

 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
Iatrogenesis
Iatrogenesis, or an iatrogenic artifact is an inadvertent adverse effect or complication resulting from medical treatment or advice, including that of psychologists, therapists, pharmacists, nurses, physicians and dentists...

, 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
Social inequality
Social inequality refers to a situation in which individual groups in a society do not have equal social status. Areas of potential social inequality include voting rights, freedom of speech and assembly, the extent of property rights and access to education, health care, quality housing and other...

 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
Biomedicine
Biomedicine is a branch of medical science that applies biological and other natural-science principles to clinical practice,. Biomedicine, i.e. medical research, involves the study of physiological processes with methods from biology, chemistry and physics. Approaches range from understanding...

. At the same time, others reject as implausible any suggestion that society reject drugs
DRUGS
Destroy Rebuild Until God Shows are an American post-hardcore band formed in 2010. They released their debut self-titled album on February 22, 2011.- Formation :...

 or drug companies, and highlight that the same drugs that are allegedly used to treat deviance
Deviance
Deviance can refer to:*Deviance *Deviance...

s 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
Ideology
An ideology is a set of ideas that constitutes one's goals, expectations, and actions. An ideology can be thought of as a comprehensive vision, as a way of looking at things , as in common sense and several philosophical tendencies , or a set of ideas proposed by the dominant class of a society to...

, resulting in a disregard for over-arching social causes such as unequal distribution of power and resources. A series of publications by Mens Sana Monographs
Mens Sana Monographs
The Mens Sana Monographs is an open-access peer-reviewed medical journal-cum-monographic series. It is Devoted to the Understanding of Medicine, Mental Health, Mind, Man and their Matrix. The Mens Sana Monographs (MSM) is an open-access peer-reviewed medical journal-cum-monographic series. It is...

 have focused on medicine as a corporate capitalist enterprise .
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 patient
Patient
A patient is any recipient of healthcare services. The patient is most often ill or injured and in need of treatment by a physician, advanced practice registered nurse, veterinarian, or other health care provider....

s. However, in some countries such as the US, ubiquitous direct-to-consumer advertising
Direct-to-consumer advertising
Direct-to-consumer advertising usually refers to the marketing of pharmaceutical products but can apply in other areas as well. This form of advertising is directed toward patients, rather than healthcare professionals. The Food and Drug Administration holds responsibility of regulating DTC...

 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
Pharmaceutical marketing
Pharmaceutical marketing , sometimes called medico-marketing, is the business of advertising or otherwise promoting the sale of pharmaceuticals or drugs. There is some evidence that marketing practices can negatively affect both patients and the health care profession...

 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
Consumer
Consumer is a broad label for any individuals or households that use goods generated within the economy. The concept of a consumer occurs in different contexts, so that the usage and significance of the term may vary.-Economics and marketing:...

, or even agents of change.

The antithesis of medicalization is the process of paramedicalization
Paramedicalization
Paramedicalization refers to the trend of people setting more and more value on alternative medicine and different beliefs about wealth and health, which are not authorized by medical science. The process runs concurrently with medicalization....

, where human conditions come under the attention of alternative medicine
Alternative medicine
Alternative medicine is any healing practice, "that does not fall within the realm of conventional medicine." It is based on historical or cultural traditions, rather than on scientific evidence....

, traditional medicine
Traditional medicine
Traditional medicine comprises unscientific knowledge systems that developed over generations within various societies before the era of modern 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
Diagnostic and Statistical Manual of Mental Disorders
The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders...

) is a primary area of alleged medicalization. For instance, the current (DSM-IV) version, lists impotence, premature ejaculation
Premature ejaculation
Premature ejaculation is a condition in which a man ejaculates earlier than he or his partner would like him to. Premature ejaculation is also known as rapid ejaculation, rapid climax, premature climax, or early ejaculation....

, jet lag
Jet lag
Jet lag, medically referred to as desynchronosis, is a physiological condition which results from alterations to the body's circadian rhythms; it is classified as one of the circadian rhythm sleep disorders...

, 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
Personality disorder
Personality disorders, formerly referred to as character disorders, are a class of personality types and behaviors. Personality disorders are noted on Axis II of the Diagnostic and Statistical Manual of Mental Disorders or DSM-IV-TR of the American Psychiatric Association.Personality disorders are...

" 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
Drapetomania
Drapetomania was a supposed mental illness described by American physician Samuel A. Cartwright in 1851 that caused black slaves to flee captivity. Today, drapetomania is considered an example of pseudoscience, and part of the edifice of scientific racism...

 - the madness of slaves who try to flee captivity). Medicalization in this area, whether through psychiatry
Psychiatry
Psychiatry is the medical specialty devoted to the study and treatment of mental disorders. These mental disorders include various affective, behavioural, cognitive and perceptual abnormalities...

 or more specifically biopsychiatry, has been most consistently and radically challenged by the antipsychiatry movement.

The HIV/AIDS pandemic allegedly caused from the 1980s a "profound re-medicalization of sexuality
Human sexuality
Human sexuality is the awareness of gender differences, and the capacity to have erotic experiences and responses. Human sexuality can also be described as the way someone is sexually attracted to another person whether it is to opposite sexes , to the same sex , to either sexes , or not being...

". The diagnosis of Premenstrual dysphoric disorder
Premenstrual dysphoric disorder
Premenstrual dysphoric disorder is a severe form of premenstrual syndrome, afflicting 3% to 8% of women. It is a diagnosis associated primarily with the luteal phase of the menstrual cycle...

 has caused some controversy, and psychologist Peggy Kleinplatz
Peggy Kleinplatz
Peggy J. Kleinplatz is a Canadian clinical professor, psychologist, and sexologist whose work often concerns optimal sexuality, opposition to the medicalization of human sexuality, and outreach to marginalized groups.- Life and career :...

 has criticized the diagnosis as medicalization of normal human behavior, that occurred while fluoxetine
Fluoxetine
Fluoxetine is an antidepressant of the selective serotonin reuptake inhibitor class. It is manufactured and marketed by Eli Lilly and Company...

 (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
Masculinity
Masculinity is possessing qualities or characteristics considered typical of or appropriate to a man. The term can be used to describe any human, animal or object that has the quality of being masculine...

 has also faced medicalization, being deemed damaging to health and requiring regulation or enhancement through drugs, technologies or therapy.

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
Medicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....

, pharmaceutical companies, and culture
Culture
Culture is a term that has many different inter-related meanings. For example, in 1952, Alfred Kroeber and Clyde Kluckhohn compiled a list of 164 definitions of "culture" in Culture: A Critical Review of Concepts and Definitions...

 at large. Participants represented a variety of disciplines, including psychiatry
Psychiatry
Psychiatry is the medical specialty devoted to the study and treatment of mental disorders. These mental disorders include various affective, behavioural, cognitive and perceptual abnormalities...

, sociology
Sociology
Sociology is the study of society. It is a social science—a term with which it is sometimes synonymous—which uses various methods of empirical investigation and critical analysis to develop a body of knowledge about human social activity...

, anthropology
Anthropology
Anthropology is the study of humanity. It has origins in the humanities, the natural sciences, and the social sciences. The term "anthropology" is from the Greek anthrōpos , "man", understood to mean mankind or humanity, and -logia , "discourse" or "study", and was first used in 1501 by German...

, history, critical race theory
Critical race theory
Critical Race Theory is an academic discipline focused upon the intersection of race, law and power.Although no set of canonical doctrines or methodologies defines CRT, the movement is loosely unified by two common areas of inquiry...

, and gender studies
Gender studies
Gender studies is a field of interdisciplinary study which analyses race, ethnicity, sexuality and location.Gender study has many different forms. One view exposed by the philosopher Simone de Beauvoir said: "One is not born a woman, one becomes one"...

. As such, topics ranged from the economics
Economics
Economics is the social science that analyzes the production, distribution, and consumption of goods and services. The term economics comes from the Ancient Greek from + , hence "rules of the house"...

 of medicalization to the creation and perpetuation of medicalized forms of identity and citizenship
Citizenship
Citizenship is the state of being a citizen of a particular social, political, national, or human resource community. Citizenship status, under social contract theory, carries with it both rights and responsibilities...

. 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
    Caesarean section
    A Caesarean section, is a surgical procedure in which one or more incisions are made through a mother's abdomen and uterus to deliver one or more babies, or, rarely, to remove a dead fetus...

    )
  • 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
    Menopause
    Menopause is a term used to describe the permanent cessation of the primary functions of the human ovaries: the ripening and release of ova and the release of hormones that cause both the creation of the uterine lining and the subsequent shedding of the uterine lining...

    , andropause
    Andropause
    Andropause or male menopause, sometimes colloquially called "man-opause" is a name that has been given to a menopause-like condition in aging men...

    , and aging as a whole should be considered physiological malfunctions or normal life processes

See also

  • Classification of Pharmaco-Therapeutic Referrals
    Classification of Pharmaco-Therapeutic Referrals
    The Classification of Pharmaco-Therapeutic Referrals is a taxonomy focused to define and group together situations requiring a referral from pharmacists to physicians regarding the pharmacotherapy used by the patients. It has been published in 2008...

  • Interventionism (medicine)
    Interventionism (medicine)
    Interventionism, when discussing the practice of medicine, is generally a derogatory term used by critics of a medical model in which patients are viewed as passive recipients receiving external treatments provided by the physician that have the effect of prolonging life, or at least of providing a...

  • Inverse benefit law
    Inverse benefit law
    The Inverse Benefit Law states that the ratio of benefits to harms among patients taking new drugs tends to vary inversely with how extensively a drug is marketed...

  • Medical anthropology
    Medical anthropology
    Medical anthropology is an interdisciplinary field which studies "human health and disease, health care systems, and biocultural adaptation". It views humans from multidimensional and ecological perspectives...

  • Medical sociology
    Medical sociology
    Medical sociology is the sociological analysis of medical organizations and institutions; the production of knowledges and selection of methods, the actions and interactions of healthcare professionals, and the social or cultural effects of medical practice...

  • Overdiagnosis
    Overdiagnosis
    Overdiagnosis is the diagnosis of "disease" that will never cause symptoms or death during a patient's lifetime. Overdiagnosis is the least familiar side effect of testing for early forms of disease – and, arguably, the most important...

  • Psychobabble
    Psychobabble
    Psychobabble is a form of prose using jargon, buzzwords and highly esoteric language to give an impression of plausibility through mystification, misdirection, and obfuscation. The term implies that the speaker of psychobabble lacks the experience and understanding necessary for proper use of a...

  • Psychopharmacology
    Psychopharmacology
    Psychopharmacology is the scientific study of the actions of drugs and their effects on mood, sensation, thinking, and behavior...

  • Quaternary prevention
    Quaternary prevention
    The quaternary prevention, concept coined by the Belgian general practitioner , are the action taken to identify patient at risk of overmedicalisation, to protect him from new medical invasion, and to suggest to him interventions, which are ethically acceptable...

  • Schooliosis
    Schooliosis
    Schooliosis, a pun on "school" and "scoliosis", is a term for a type of medical misdiagnosis. The word was coined by Petr Skrabanek and James McCormick....

  • Sociology of health and illness
    Sociology of health and illness
    The Sociology of Health and Illness examines the interaction between society and health. The objective of this topic is to see how social life has an impact on morbidity and mortality rate, and vice versa...


Further reading


External links

  • Public site concerning medicalization by Markku Myllykangas and Raimo Tuomainen
    Raimo Tuomainen
    Raimo Sakari Tuomainen is a Finnish health sociologist and one of the authorities in so called Kuopio discipline, which emphasizes the need to control the expansion of medicalization in Western countries. His publications deal also with religion, science, demography and health care administration...

    , Kuopio
    Kuopio
    Kuopio is a city and a municipality located in the region of Northern Savonia, Finland. A population of makes it the ninth biggest city in the country. The city has a total area of , of which is water and half forest...

    , Finland
    Finland
    Finland , officially the Republic of Finland, is a Nordic country situated in the Fennoscandian region of Northern Europe. It is bordered by Sweden in the west, Norway in the north and Russia in the east, while Estonia lies to its south across the Gulf of Finland.Around 5.4 million people reside...

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