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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".

Development of the concept[link]

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. 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).^[2]

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 as a result of 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^[who?] 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[link]

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.^[3] A series of publications by Mens Sana Monographs have focused on medicine as a corporate capitalist enterprise.^[4][5][6]

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[link]

According to Kittrie, a number of phenomena considered "deviant", such as alcoholism, drug addiction and mental illness, were originally considered as moral, then legal, and now medical problems.^[7]:1[8] As a result of these perceptions, peculiar deviants were subjected to moral, then legal, and now medical modes of social control.^[7]:1 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.^[7]:1[9]:36 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.^[10]:70 As scholars have long argued, governmental and medical institutions code menaces to authority as mental diseases during political disturbances.^[11]:14 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.^[12] Moreover, the pressure for medicalization also comes from society itself.^[12] 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.^[12] When faced with demands for measures to curtail smoking in public, binge-drinking, gambling or obesity, ministers say that “we must guard against charges of nanny statism.”^[12] The “nanny state” has turned into the “therapeutic state” where nanny has given way to counselor.^[12] Nanny just told people what to do; counselors also tell them what to think and what to feel.^[12] The “nanny state” was punitive, austere, and authoritarian, the therapeutic state is touchy-feely, supportive — and even more authoritarian.^[12] According to 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.”^[13]:515 Faced with the problem of “madness,” Western individualism proved to be ill prepared to defend the rights of the individual: modern man has no more right to be a madman than medieval man had a right to be a heretic because if once people agree that they have identified the one true God, or Good, it brings about that they have to guard members and nonmembers of the group from the temptation to worship false gods or goods.^[13]:496 A secularization of God and the medicalization of good resulted in the post-Enlightenment version of this view: once people agree that they have identified the one true reason, it brings about that they have to guard against the temptation to worship unreason — that is, madness.^[13]:496

The HIV/AIDS pandemic allegedly caused from the 1980s a "profound re-medicalization of sexuality".^[14][15] 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.^[16] 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.^[17]

An 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." Citing anecdotal case studies they were familiar with, the authors suggested further systematic research into this field to better understand the extent of influence this inappropriate medicalization has on public perception and the medical field.^[18]

See also[link]

• Interventionism (medicine)
• Sociology of health and illness

References[link]

Further reading[link]

• 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)
• Illich, Ivan (July 1975). "The medicalization of life". Journal of Medical Ethics 1 (2): 73–77. PMC 1154458. PMID 809583. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1154458/pdf/jmedeth00176-0022.pdf. 

Ian Robert Dowbiggin (born 1952) is a professor in the History department at the University of Prince Edward Island and writer on the history of medicine, in particular topics such as euthanasia and physician-assisted suicide. His research and publications have been funded by the Social Sciences and Humanities Research Council of Canada and the Associated Medical Services. In 2011, he was made a Fellow of the Royal Society of Canada.^[1]

Euthanasia[link]

Dowbiggin has written on the history of the euthanasia movement, including A Merciful End: The Euthanasia Movement in Modern America (2003) and A Concise History of Euthanasia: Life, Death, God, and Medicine (2005). He links the rise of euthanasia to an intellectual shift that took place in the late 19th and early 20th centuries, away from the moral precepts of the Judeo-Christian tradition.^[2] One important cause of this shift was Darwinism, which had questioned the right of the "unfit" – such as the mentally handicapped – to live.^[2] Along with other intellectual currents such as social progressivism and Unitarianism, this led physicians and people like the founder of the Euthanasia Society of America, Charles Francis Potter, to accept the practice of euthanasia.^[2][3]

According to a review of A Concise History of Euthanasia by Sandra Woien in the American Journal of Bioethics, Dowbiggin sees euthanasia and eugenics as the inevitable results of abandoning the moral guidance of religion in medicine.^[4] Woien found that the book overemphasised the relationship between eugenics and euthanasia, and muddied "important conceptual and practical distinctions", but allowed that it may be "useful in understanding the historical context of euthanasia."^[4]

The Canadian Historical Association awarded Dowbiggin the Wallace K. Ferguson Prize for A Merciful End, stating that the book "gives a clear and evenly-balanced study of the history of euthanasia in the United States since the latter part of the nineteenth century", and concluded that it overall is a "masterful explanation of the way in which changing social, economic and disease-related factors have affected public interest in euthanasia."^[5]

Dowbiggin has spoken against euthanasia legislation and said that the Netherlands exists as a "cautionary lesson" for Canada in particular, showing that those places that "take a permissive attitude to assisted suicide keep pushing the boundaries."^[6]

Sterilization[link]

Dowbiggin published the book The Sterilization Movement and Global Fertility in the Twentieth Century in 2008. Drawing on scholarly sources, the book is primarily an account of sterilization as used for the purposes of eugenics and population control, examples including the use of sterilization by European fascists and the Indian mass sterilization program carried out during the 1975–1977 Emergency in India, which contributed to the downfall of Indira Gandhi's government.^[7]

Ulf Högberg, guest researcher of Public Health and Clinical Medicine at Umeå University, argued in the European Journal of Public Health that, "The book is most impressive, finely tuning the history between choice and compulsion of sterilization policy; sometimes it has been a fine line in between, sometimes an abyss of abuse of human rights."^[8]

A review in the The New England Journal of Medicine, by Carolyn Westhoff, an official of the Planned Parenthood Federation of America, summed up by agreeing with the book's conclusion that "advocacy of sterilization as a solution to population growth leads to serious problems when that agenda overrides individual values and individual autonomy", but differed from it in stating that "Voluntary sterilization, however, deserves its great popularity and will remain valuable as one part of a broader menu of options for family planning." ^[7]

Partial bibliography[link]

• A Concise History of Euthanasia: Life, Death, God, and Medicine (2005)
• A Merciful End: The Euthanasia Movement in Modern America (2003)
• Suspicious Minds: The Triumph of Paranoia in Everyday Life (1999)
• Keeping America Sane: Psychiatry and Eugenics in the United States and Canada, 1880-1940 (1997)
• Inheriting Madness: Professionalization and Psychiatric Knowledge in 19th Century France (1991)

References[link]

External links[link]

• Dowbiggin's page at UPEI