The increasing number of psychiatric diagnoses in children and the rising use of psychotropic medications described in this report are part of a larger trend toward the medicalization of society. Over the past four decades, an increasing number of human conditions have been medicalized, including alcoholism, obesity, anorexia, erectile dysfunction, menopause, Alzheimer disease, and sleep disorders. To these we can add the increased diagnoses of attention deficit hyperactivity disorder (ADHD), Asperger syndrome, and childhood bipolar disorder. The broad expansion of medical categories and their subsequent treatment have brought more individuals and life conditions and problems into medical jurisdiction.
Medicalization occurs when previously nonmedical problems become defined (and treated) as medical problems, usually as an illness or disorder. The main concern about medicalization is how something becomes defined as medical and with what consequences. While one commonly expressed concern is “overmedicalization,” the social process itself, like urbanization or secularization, is not necessarily either good or bad. Medicalization is on a continuum, with some conditions more medicalized than others, and we can also speak of demedicalization (which has happened with masturbation and homosexuality) — although many more conditions have been medicalized. Medical categories can expand or contract. When ADHD was first diagnosed and treated, it was seen as a disorder for children, mainly boys. But as the focus of the definition shifted to attention and away from hyperactivity, an increasing number of girls were diagnosed with it. Soon we began to see adolescents diagnosed with ADHD, and in the past two decades we have seen the rise of adult ADHD. The thresholds for ADHD, both in terms of age and behavior, have shifted so that now it can be deemed a lifetime disorder affecting a far larger number of people.
The engines underlying medicalization have shifted as well.1 In the 1970s, physicians were key, but currently the pharmaceutical industry, consumer and advocacy groups, and the health insurance industry have become more powerful engines. Physicians are now sometimes just gatekeepers for medicalization, as exemplified in the pharmaceutical mantra, “Ask your doctor if (name of drug) is right for you.” Direct-to-consumer advertising has become an important vehicle for medicalizing new categories and their drug treatments.
What are the problems with medicalization? I can list just a few here: (1) everything becomes pathologized, turning all human difference into medical problems; (2) medicine gets to define what is normal, whether it is behavior, body shape, or learning ability; (3) attention is focused on the individual and away from the social context, which may be the primary source of the problem; (4) medicine is viewed as a commodity; and (5) “consumers” are at risk for the adverse side effects associated with the powerful medications often used to respond to medicalized problems. For these reasons, it is important to recognize medicalization when it is occurring.
Peter Conrad is the Harry Coplan Professor of Social Sciences in the Department of Sociology at Brandeis University.
- 1. P. Conrad, The Medicalization of Society (Baltimore, Md.: Johns Hopkins University Press, 2007).↵