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Medicalization is the process by which human conditions and problems come to be defined and treated as
medical conditions A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not immediately due to any external injury. Diseases are often known to be medical conditions that a ...
, and thus become the subject of medical study, diagnosis,
prevention Prevention may refer to: Health and medicine * Preventive healthcare, measures to prevent diseases or injuries rather than curing them or treating their symptoms General safety * Crime prevention, the attempt to reduce deter crime and crimin ...
, 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 A social welfare model is a system of social welfare provision and its accompanying value system. It usually involves social policies that affect the welfare of a country's citizens within the framework of a market or mixed economy. Elements of ...
. Medicalization may also be termed ''pathologization'' or (pejoratively) "
disease mongering Disease mongering is a pejorative term for the practice of widening the diagnostic boundaries of illnesses and aggressively promoting their public awareness in order to expand the markets for treatment. Among the entities benefiting from selling a ...
". 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.


Development of the concept

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. The term ''medicalization'' entered the sociology literature in the 1970s in the works of
Irving Zola Irving Kenneth Zola (1935–1994) was an American activist and writer in medical sociology and disability rights. Early life and education Irving Kenneth Zola, born in 1935, in Newton, Massachusetts. He came from a working class Jewish family ...
, Peter Conrad and Thomas Szasz, among others. According to
Eric Cassell Eric Jonathan Cassell (August 29, 1928September 24, 2021) was an American physician and bioethicist. Early life and education Eric Jonathan Goldstein was born on August 29, 1928, in New York City. He and his brother changed their surname to Ca ...
'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. 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 Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterised by excessive amounts of inattention, hyperactivity, and impulsivity that are pervasive, impairing in multiple contexts, and otherwise age-inapp ...
). 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 Iatrogenesis is the causation of a disease, a harmful complication, or other ill effect by any medical activity, including diagnosis, intervention, error, or negligence. "Iatrogenic", ''Merriam-Webster.com'', Merriam-Webster, Inc., accessed 2 ...
, 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 In medicine, a side effect is an effect, whether therapeutic or adverse, that is secondary to the one intended; although the term is predominantly employed to describe adverse effects, it can also apply to beneficial, but unintended, consequenc ...
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 Feminism is a range of socio-political movements and ideologies that aim to define and establish the political, economic, personal, and social equality of the sexes. Feminism incorporates the position that society prioritizes the male po ...
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 Capitalism is an economic system based on the private ownership of the means of production and their operation for profit. Central characteristics of capitalism include capital accumulation, competitive markets, price system, private p ...
society. They argued that medicine disguised the underlying causes of disease, such as
social inequality Social inequality occurs when resources in a given society are distributed unevenly, typically through norms of allocation, that engender specific patterns along lines of socially defined categories of persons. It posses and creates gender c ...
and poverty, and instead presented health as an individual issue. Others 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) 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 Hans-Georg Gadamer (; ; February 11, 1900 – March 13, 2002) was a German philosopher of the continental tradition, best known for his 1960 ''magnum opus'', '' Truth and Method'' (''Wahrheit und Methode''), on hermeneutics. Life Family a ...
'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 Alternative medicine is any practice that aims to achieve the healing effects of medicine despite lacking biological plausibility, testability, repeatability, or evidence from clinical trials. Complementary medicine (CM), complementary and al ...
) 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

A 2002 editorial in the ''
British Medical Journal ''The BMJ'' is a weekly peer-reviewed medical trade journal, published by the trade union the British Medical Association (BMA). ''The BMJ'' has editorial freedom from the BMA. It is one of the world's oldest general medical journals. Origina ...
'' 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: For many years, marginalized psychiatrists (such as
Peter Breggin Peter Roger Breggin (born May 11, 1936) is an American psychiatrist and critic of shock treatment and psychiatric medication and Covid-19 response. In his books, he advocates replacing psychiatry's use of drugs and electroconvulsive therapy wi ...
,
Paula Caplan Paula Joan Caplan (July 7, 1947 – July 21, 2021) was an American psychologist, activist, writer, and artist. She was an associate at Harvard University's DuBois Institute, director of the Voices of Diversity Project, and a past Fellow at the ...
, Thomas Szasz) and outside critics (such as
Stuart A. Kirk Stuart A. Kirk holds the Marjorie Crump Chair in Social Welfare at UCLA and is a former psychiatric social worker. His research interests include mental health issues, particularly the creation and use of the Diagnostic and Statistical Manual of Men ...
) 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 The American Psychiatric Association (APA) is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the largest psychiatric organization in the world. It has more than 37,000 members are involve ...
(e.g., Robert Spitzer,
Allen Frances Allen J. Frances (born 2 October 1942) is an American psychiatrist. He is currently Professor and Chairman Emeritus of the Department of Psychiatry and Behavioral Sciences at Duke University School of Medicine. He is best known for serving as cha ...
).
Benjamin Rush Benjamin Rush (April 19, 1813) was a Founding Father of the United States who signed the United States Declaration of Independence, and a civic leader in Philadelphia, where he was a physician, politician, social reformer, humanitarian, educato ...
, 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". 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. As scholars have long argued, governmental and medical institutions code menaces to authority as mental diseases during political disturbances. The HIV/AIDS pandemic allegedly caused from the 1980s a "profound re-medicalization of
sexuality Human sexuality is the way people experience and express themselves sexually. This involves biological, psychological, physical, erotic, emotional, social, or spiritual feelings and behaviors. Because it is a broad term, which has varied wi ...
". The diagnosis of
premenstrual dysphoric disorder Premenstrual dysphoric disorder (PMDD) is a mood disorder characterized by emotional, cognitive, and physical symptoms that cause significant distress or impairment in menstruating women during the luteal phase of the menstrual cycle. The symptom ...
(PMDD) has caused some controversy when fluoxetine (also known as Prozac) was being repackaged as a PMDD therapy under the trade named Sarafem. The psychologist
Peggy Kleinplatz Peggy Joy Kleinplatz is a Canadian clinical psychologist and sexologist whose work often concerns optimal sexuality, opposition to the medicalization of human sexuality, and outreach to marginalized groups.Alexander, Brian (May 22, 2008)What's 'no ...
has criticized the diagnosis as the medicalization of normal human behavior.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 Other medicalized aspects of women's health include infertility,
breastfeeding Breastfeeding, or nursing, is the process by which human breast milk is fed to a child. Breast milk may be from the breast, or may be expressed by hand or pumped and fed to the infant. The World Health Organization (WHO) recommends that brea ...
, the childbirth process, and
postpartum depression Postpartum depression (PPD), also called postnatal depression, is a type of mood disorder associated with childbirth, which can affect both sexes. Symptoms may include extreme sadness, low energy, anxiety, crying episodes, irritability, and cha ...
. 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. Specifically, erectile dysfunction was once considered a natural part of the aging process in men, but has since been medicalized as a problem,
late-onset hypogonadism Late-onset hypogonadism (LOH) or testosterone deficiency syndrome (TDS) is a condition in older men characterized by measurably low testosterone levels and clinical symptoms mostly of a sexual nature, including decreased desire for sex, fewer spon ...
. According to Kittrie, a number of phenomena considered "deviant", such as
alcoholism Alcoholism is, broadly, any drinking of alcohol that results in significant mental or physical health problems. Because there is disagreement on the definition of the word ''alcoholism'', it is not a recognized diagnostic entity. Predomin ...
, drug addiction, prostitution, pedophilia, and masturbation ("self-abuse"), were originally considered as moral, then legal, and now medical problems. Innumerable other conditions such as obesity, smoking cigarettes, draft malingering, bachelorhood, divorce, unwanted pregnancy, kleptomania, and grief, have been declared diseases by medical and psychiatric authorities. Due to these perceptions, peculiar deviants were subjected to moral, then legal, and now medical modes of social control. Similarly, Conrad and Schneider concluded their review of the medicalization of deviance by identifying three major paradigms that have reigned over deviance designations in different historical periods: deviance as sin; deviance as crime; and deviance as sickness. According to Mike Fitzpatrick, resistance to medicalization was a common theme of the
gay liberation The gay liberation movement was a social and political movement of the late 1960s through the mid-1980s that urged lesbians and gay men to engage in radical direct action, and to counter societal shame with gay pride.Hoffman, 2007, pp.xi-xiii. ...
,
anti-psychiatry Anti-psychiatry is a movement based on the view that psychiatric treatment is often more damaging than helpful to patients, highlighting controversies about psychiatry. Objections include the reliability of psychiatric diagnosis, the questionab ...
, 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. Moreover, the pressure for medicalization also comes from society itself. 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".


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. 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.


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 Catalysis () is the process of increasing the rate of a chemical reaction by adding a substance known as a catalyst (). Catalysts are not consumed in the reaction and remain unchanged after it. If the reaction is rapid and the catalyst recyc ...
of medicalization. Titles such as "The making of a disease" or "Sex, drugs, and marketing" critique the
pharmaceutical industry The pharmaceutical industry discovers, develops, produces, and markets drugs or pharmaceutical drugs for use as medications to be administered to patients (or self-administered), with the aim to cure them, vaccinate them, or alleviate symptoms. ...
for shunting everyday problems into the domain of professional
biomedicine Biomedicine (also referred to as Western medicine, mainstream medicine or conventional medicine)
. 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 Social norms are shared standards of acceptance, acceptable behavior by groups. Social norms can both be informal understandings that govern the behavior of members of a society, as well as be codified into wikt:rule, rules and laws. Social normat ...
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 An ideology is a set of beliefs or philosophies attributed to a person or group of persons, especially those held for reasons that are not purely epistemic, in which "practical elements are as prominent as theoretical ones." Formerly applied prim ...
, resulting in a disregard for overarching social causes such as unequal distribution of power and resources. A series of publications by Mens Sana Monographs have focused on medicine as a
corporate A corporation is an organization—usually a group of people or a company—authorized by the state to act as a single entity (a legal entity recognized by private and public law "born out of statute"; a legal person in legal context) and re ...
capitalist enterprise. 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. This has been attributed to the commodification of healthcare amd the role of parties other than doctors such as insurance companies, the pharmaceutical industry, and the government, referred to collectively as countervailing powers. 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 An advocate is a professional in the field of law. Different countries' legal systems use the term with somewhat differing meanings. The broad equivalent in many English law–based jurisdictions could be a barrister or a solicitor. However, ...
, 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 transformingn medicine. One aspect is ''pharmaceuticalization'', the influence of the use of
pharmaceutical drugs A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to diagnose, cure, treat, or prevent disease. Drug therapy (pharmacotherapy) is an important part of the medical field and r ...
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.


See also

* Interventionism (medicine) *
Medical model ''Medical model'' is the term coined by psychiatrist R. D. Laing in his ''The Politics of the Family and Other Essays'' (1971), for the "set of procedures in which all doctors are trained". It includes complaint, history, physical examinati ...
*
Sociology of health and illness The sociology of health and illness, sociology of health and wellness, or health sociology examines the interaction between society and health. As a field of study it is interested in all aspects of life, including contemporary as well as hist ...
* Social stigma


References


Further reading

* * Horwitz, Allan, and Wakefield, Jerome (2007).''The Loss of Sadness: How Psychiatry Has Transformed Normal Sadness into Depressive Disorder.'' Oxford University Press. * Lane, Christopher (2007). ''Shyness: How Normal Behavior Became a Sickness.'' Yale University Press. * * * {{Authority control Medical sociology Medical controversies Social constructionism Social problems in medicine