Medicalization Essay ⋆ Essays on Controversial Topics ⋆ EssayEmpire

Medicalization is the process by which nonmedical problems become defined and treated as medical problems, usually as illnesses or disorders. This process can occur on multiple levels: a conceptual level, with the development of a medical definition of a problem; an interactional level, where the physician applies a medical diagnosis to a nonmedical problem and administers treatment; and the institutional level, where organizations advocate a medical approach.

One area drawing considerable attention is the medicalization of deviance. Behaviors once considered “badness” became viewed, through the process of medicalization, more as “sickness.” Here, medicalization diminishes individual responsibility, since experts now look at the behavior as something occurring outside the control of the individual, though often in the person’s physiology. Some examples of medicalized deviance include madness, alcoholism, attention deficit hyperactivity disorder (ADHD), addictions, and infertility. Another area of medicalization is everyday life processes including childbirth, menstrual discomfort (premenstrual syndrome, or PMS), menopause, aging, and death.

Medicalization need not be complete or discrete, but can be full, partial, expansive, and emergent. With full medicalization, as is the case with childbirth, nearly all the processes and interventions are encompassed by medical definitions and under medical control. Menopause is an example of partial medicalization; some physicians and their patients view menopause as a hormone deficiency state requiring treatment, generally through the medication of hormone replacement therapy, while others feel it is a natural life process that does not need medical intervention. With expansive medicalization, the definitional boundaries for a medicalized problem can expand over time. For example, the diagnosis of attention deficit hyperactivity disorder originally applied only to children, but in the 1990s grew to include adults also, increasing the purview of medicalization. Emergent medicalization includes problems promoted by some stakeholders (e.g., physicians and/or consumer groups) as official diagnostic categories that still await acceptance as medical disorders by significant parts of the medical profession. Examples include “Internet addiction,” “sex addiction,” and “female sexual dysfunction.”

Medicalization is a two-way process, incorporating expansion and possible contraction. Demedicalization happens when a medicalized problem no longer retains its medical definition, indicating that medical diagnoses or interventions no longer are appropriate solutions. Demedicalization generally occurs only when organized interest groups challenge medical definitions and control. Perhaps the best example is the gay rights movement convincing the American Psychiatric Association in 1973 to no longer define homosexuality as a psychiatric disorder. However, only a few processes become demedicalized as compared to the large number of behaviors and conditions that become medicalized.

Most sociologists have been critical of medicalization, referring to it as the “over-medicalization of society” or the “medicalization of ills,” emphasizing its potential for adverse social and medical consequences. They argue that medicalization may decontextualize social problems so that they are viewed solely as individual concerns devoid of a social context. Some types of medicalization produce increased risks or adverse medical consequences associated with pharmaceutical drugs (e.g., with treatment of menopause, an increased incidence of breast cancer, coronary heart disease, and stroke with the use of hormone replacement therapy). Unnecessary therapeutic interventions may contribute to rising health care costs despite uncertain benefits. Additionally, some scholars note that medicalization is yet another way to extend social control onto more aspects of daily life through the use of medical forms of social control (e.g., drugs, types of surgery, or medical surveillance).

While critics voice concern about overmedicalization, some groups with specific problems or disorders advocate for medicalization. Here, groups of people with or representing contested illnesses are vying for a diagnosis, in part to validate their experience of illness, since many lack definite physical symptoms. Some examples of contested illnesses are fibromyalgia, Gulf War syndrome, and Multiple Chemical Sensitivity Disorder. Another potential benefit of medicalization is that it can reduce the stigma associated with certain problems through redefinition as physiological or biological rather than behavioral in origin.

Initially, the major facilitating forces for medicalization (e.g., for ADHD and menopause) were the medical profession, interest groups advocating for the medicalization of controversial disorders contested by the medical profession (e.g., alcoholism and post-traumatic stress disorder), and interprofessional struggles (e.g., obstetricians medicalizing childbirth to eliminate midwives). However, because of dramatic increases in medical knowledge and the reorganization of health care during the past 25 years, a few scholars have reframed the process as “biomedicalization” to reflect the impacts of technology and biology on society. Others suggest that medicalization continues and it is just the engines behind medicalization that are shifting to biotechnology, consumers, and managed health care in the 21st century.

Advances in drug development, relaxation of Food and Drug Administration requirements concerning off-label uses of drugs, and direct-to-consumer advertising have enabled the pharmaceutical industry to medicalize problems as they create or expand markets, such as advertising medications for sexual performance and “dysfunction” or for poor performance in social situations (social anxiety disorder). Rapid advances in genetic medicine harken the potential of increased medicalization; genetic enhancement of bodies and/or cognitive abilities will likely lead to new medical categories and interventions. Consumers have become an important factor in the medicalization process, fueled by advertisements in the media, promotion by the medical profession, and widespread dissemination of medical information and advertising on the Internet. Illustrating this are the increasing demands for cosmetic surgery, the rise of adult ADHD, and the use of human growth hormones for treatment of idiopathic short stature. Here, as with contested illness, laypeople play a key role in medicalization. Finally, insurance companies concerned with rising health care costs have become key decision makers, limiting payment for what they consider appropriate treatments. These countervailing forces are likely to chart the future course of medicalization.

Bibliography:

Clarke, Adele E., Janet K. Shim, Laura Mamo, Jennifer Ruth Fosket, and Jennifer R. Fishman. 2003. “Biomedicalization: Technoscientific Transformations of Health, Illness, and US Biomedicine.” American Sociological Review 68(2):161-94.
Conrad, Peter. 1992. “Medicalization and Social Control.” Annual Review of Sociology, 18:209-32.
Conrad, Peter. 2005. “The Shifting Engines of Medicalization.” Journal of Health and Social Behavior 46:3-14.
Conrad, Peter. 2007. The Medicalization of Society. Baltimore: Johns Hopkins University Press.
Conrad, Peter and Joseph Schneider. 1980. From Badness to Sickness: The Medicalization of Deviance. Philadelphia: Temple University Press.
Conrad, Peter and Cheryl Stults. 2008. “Medicalization and Contestation.” Contours of Contestation. Toronto, ON: University of Toronto Press.

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