The uses of the concept of medicalisation

How useful is the concept of medicalisation for understanding shifting ideas about health and illness?

“As science and technology advances, age related processes often become medicalised and enter the domain of powerful social establishments like the health industry. When such human experiences come under medical dominion, the experience is said to become medicalized; this entails the definition and treatment of a problem under a medical framework “.

Peter Conrad

The quote above comes from Conrad, a leading sociologist in the field of health and medicine and he stated that “medicalization describes a process by which nonmedical problems become defined and treated as medical problems, usually in terms of illnesses and disorders” (Kawachi and Conrad: 1996). The essay question asks one to assess the usefulness of the concept of medicalization. In order to fully answer and understand the question I will have to look into the term medicalization and explore its origins and meaning. The term is such an ambiguous, complex but contested process and was first used and coined during the 1960’s and grew in popularity during the 1970s. this was due to the fact that it was linked with the concept of social control and was prominent in the works of key figures including Conrad, Thomas Szasz and Irving Zola. Furthermore I would have to understand how useful the concept is for understanding the shifting ideas about health and illness.

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The concept of medicalization has educated the sociology of health and illness for many years now. Typically, it has been deliberated and examined with critical nuance, though some key thinkers within the discipline have suggested that it is not unequivocally negative. Conrad criticised and disputed that the development and growth 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 (Conrad 1973). Medicalization “describes a process by which non-medical problems become defined and treated as medical problems, usually in terms of illness or disorders” (Gabe et al. 2004:59) and likewise be simply classified as a procedure of increased medical intervention into areas which would more often than not be outside of the medical province.

Medicalization is deemed imperative because it means to make something a medical matter. What’s more, it explains a situation or predicament which had been previously explained in a moral, religious or social terms now become defined as the subject of medical and scientific knowledge.

Many years ago for example some children were deemed and regarded as problematic, misbehaving and unruly. Some adults were shy and men who were balding just wore hats to hide it. And that was that. Nevertheless, nowadays all these descriptions could and possibly would be attributed to a type of illness or disease and be given a diagnosis or medicine to treat it in some cases. Medicalization explains this. Likewise, “medicalization has been applied to a whole variety of problems that have come to be defined as medial, ranging from childbirth and the menopause through to alcoholism and homosexuality (Gabe et al. 2006: 59). Furthermore, the term explains the process in where particular characteristics of every day life become medically explained, thus come under the authority of doctors and other health professionals to study, diagnose, prevent and or treat the problem.

The idea of medicalization is perhaps “related only indirectly to social constructionanism, in that it does not question the basis of medical knowledge as such, but challenges its application”. Nettleton continues and states that is “draws attention to the fact that medicine operates as a powerful institution of social control” (Nettleton 2006: 25). It does this by claiming expertise in areas in life which previously were not regarded as medical problems or matters. This includes such life stages such as ageing, childbirth, alcohol consumption and childhood behaviour moreover, the “availability of new pharmacological treatments and genetic testing intensifies these processes… thus it constructs, or redefines, aspects of normal life as medical problems”. (Conrad and Schneider 1990 as cited in Nettleton 2006: 25).

Medicalization can occur on three different and particular levels according to Conrad and Schneider (1980). The first was explained as “conceptually when a medical vocabulary is used to define a problem”. In some instances, doctors do not have to be involved and an example if this is AA.

The second was the institutional level, “institutionally, when organizations adopt a medical approach to treating a problem in which they specialise” and the third was “at the level of doctor – patient interaction when a problem is defined as a medical and medical treatment occurs” (as cited in Gabe et al 2004:59). These examples all involve doctors and their treatments directly, not including alcoholism which has other figures to help people such as the AA.

The third level was the “interactional level” and this was where the problem, social problem, becomes defined as medical and medicalization occurs as part of a doctor-patient interaction.

Medicalization shows the shifting ideas about health and illness. Health and illness does not only include such things as influenza or the cold, but deviant behaviours. Deviant behaviours which were once merely described as criminal, immoral or naughty before have now been labelled with medical meanings. Conrad and Schneider (1992, as cited in Gabe 2004: 59) a “five-staged sequential process” of medicalizing deviant behaviour.

Stage one involves the behaviour itself as being deviant. ‘Chronic drunkenness’ was regarded merely as “highly undesirable”, before it was medically labelled as ‘chronic drunkenness’. The second stage “occurs when the medical conception of a deviant behaviour is announced in a professional medical journey” according to Conrad and Schneider.

Self-fulfilling prophecy is a sociological term coined and associated with the 20th century sociologist, Robert K. Merton. He explained the definition in his book “Social Theory and Social Structure” which was published in 1949. He explained it as statement that changes ones action and therefore comes true, that:

-“The self-fulfilling prophecy is, in the beginning, a false definition of the situation evoking a new behaviour which makes the original false conception come ‘true’. This specious validity of the self-fulfilling prophecy perpetuates a reign of error. For the prophet will cite the actual course of events as proof that he was right from the very beginning”

(Merton 1968: 477)

In other words, the prophecy is false however it is made true by a person’s actions. The prediction, even if it is true or not, will affect the outcome of a situation or the way a group or one would behave. We can link this into the labelling theory, and labelling someone as a criminal. Us treating that person as a criminal may entice them to harbour and act out criminal ways as that is what they have been labelled and expected to be.

Medicalization can too be linked with the self fulfilling prophecy as it has been regarded as being helpful in dealing with long-term mental illness such as anxiety disorders. Many have suggested that the self-fulfilling prophecy has led to greater success in treating difficult illnesses and has been beneficial to medicalization.

Broom and Woodward (2008) suggested that “when medical explanations were mobilised to enhance the coherence of the patient’s experience of symptoms, patients found medicalization to be helpful”.

A prominent thinker in the idea of medicalization was Ivan Illich, who studied it profusely and was very influential, in fact being one of the earliest philosophers to use the term “medicalization”. Illich’s appraisal of professional medicine and particularly his use of the term medicalization lead him to become very influential within the discipline and is quoted to have said that “Modern medicine is a negation of health. It isn’t organized to serve human health, but only itself, as an institution. It makes more people sick than it heals.”

Illich attributed medicalization “to the increasing professionalization and bureaucratization of medical institutions associated with industrialization” (Gabe et al 2004: 61). He supposed that due to the development of modern medicine, it created a reliance on medicine and doctors thus taking away peoples ability to look after themselves and “engage in self care”.

In his book “Limits to medicine: Medical nemesis” (1975) Illich disputed that the medical profession in point of fact harms people in a process known as ‘iatrogenesis’. This can be elucidated as when there is an increase in illness and social problems as a direct result of medical intervention. Illich saw this occurring on three levels.

The first was the clinical iatrogenesis. These involved serious side-effects which were are often worse than the original condition. The negative effects of the clinical intervention outweighed the positive and it also conveyed the dangers of modern medicine. There were negative side effects of medicine and drugs, which included poisoning people. In addition, infections which could be caught in the hospital such as MRSA and errors caused my medical negligence.

The second level was the social iatrogenesis whereby the general public is made submissive and reliant on the medical profession to help them cope with their life in society. Furthermore all suffering is hospitalised and medicine undermines health indirectly because of its impact on social organisation of society. In the process people cease to give birth, for example, be sick or die at home

And the third level is cultural iatrogenesis, which can also be referred to as the structural. This is where life processes such as aging and dying become “medicalized” which in the process creates a society which is not able to deal with natural life process thus becoming a culture of dependence. Moreover, people are dispossessed of their ability to cope with pain or bereavement for example as people rely on medicine and professionals. (Illick 1975)

It was said that women’s bodies were being medicalized. Sociologists such as Ehrenreich and English (1978) had argued that women’s bodies were being medicalized. Menstruation and pregnancy had come to be seen as medical problems requiring interventions such as hysterectomies. Nettleton furthered this notion and discussed this in relation to childbirth. The Medicalisation of childbirth is as a result of professional dominance. She stated that “the control of pregnancy and childbirth has been taken over by a predominantly male medical profession”.

Medicine can thus be regarded as patriarchal and exercising an undue social control over women’s lives. From conception to the birth of the baby, the women are closely monitored thus medical monitoring and intervention in pregnancy & childbirth are now routine processes. Childbirth is classified as a ‘medical problem’ therefore “it becomes conceptualized in terms of clinical safety, and women are encouraged to have their babies in hospitals” (Nettleton 2006: 26). This consequently results in women being dependent on medical care.

Nevertheless recent studies and evidence have shown that it may actually be safer to have babies at home because “there would have been less susceptible to infection and technocological interference” (Oakley 1884, as cited in Nettleton 2006: 26)

“Medicalization combines phenomenological and Marxist approaches of health and illness… in that it considers definitions of illness to be products of social interactions or negotiations which are inherently unequal” (Nettleton 2006: 26). Marxism discussed medicalization and linked it with oppression, arguing that medicine can disguise the underlying causes of disease which include poverty and social inequality. In the process they see health as an individual problem, rather than a society’s problem.

Medicalization has often been claimed to be beneficiary, but also expensive, which may not always be apparent and obvious. It 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 tends to be used rather than a social model. “It constructs, or redefines, aspects of normal life as medical problems” (Nettleton 2006: 26).

Concluding this essay, the concept of medicalization started with the medical dominance which involved the increase of medicine’s influence and labelling over things regarded as ‘normal’ life events and experiences. However in recent time, this view of a submissive lay populace, in thrall to expansionist medicine, has been challenged. As a consequence, as we enter a post-modern era, with increased concerns over risk and a decline in the trust of expert authority, many sociologists argue “that the modern day ‘consumer’ of healthcare plays an active role in bringing about or resisting medicalization”. Furthermore “Such participation…can be problematic as healthcare consumers become increasingly aware of the risks and uncertainty surrounding many medical choices”. Moreover “the emergence of the modern day consumer not only raises questions about the notion of medicalisation as a uni-dimensional concept, but also requires consideration of the specific social contexts in which medicalisation occurs” (Ballard and Elston 2005). In addition they suggest that as we enter a post-modern era, conceptualizing medicalisation as a uni-dimensional or as the result of medical dominance primarily is insufficient.

Medicalization has been referred to as “the processes by which social phenomena come to be perceived and treated as illnesses” (Ballard and Elston 2005). It is the process in by issues and experiences that have previously been accounted for in religious, moral, or social contexts then become defined as the subject of scientific medical knowledge.

The idea itself questions the belief that physical conditions themselves constitute an illness. It argues that the classification and identification of diseases is socially constructed and. It has been suggested that medicine is seen as being instilled with subjective assumptions of the society in which it developed. Moreover, it argues that the classification and identification of diseases is socially constructed and, along with the rest of science, is far from achieving the ideals of objectivity and neutrality. The medical thesis “has much to recommend…including the creation of new understanding of the social processes involved in the development and response to medical diagnosis and treatment” (Gabe et al. 2004: 62).

The concept is useful for understanding shifting ideas about health and illness in a sense that the “developments also contribute to the construction of new medical categories” labelling every day life experiences which one may go through as a medical issue.

It can be criticised because it enables a dependence on science, medicine and doctors and promoted consumerism. For instance it would have a proposed increase in pharmaceuticalisation without medicalization because medical profession would have by-passed. For example it would promote consumerism, and people would purchase drugs and medicines over the internet, or in pharmacies. This could be unsafe. Gabe at. Al noted that while there are criticisms to be made, “medicalization remains a useful concept for sociologists of health and illness” (Gabe et al 2004: 62).