Medicalization

Peter ConradThe 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.

Ref­er­ences
  • 1. P. Con­rad, The Med­ical­iza­tion of Soci­ety (Bal­ti­more, Md.: Johns Hop­kins Uni­ver­sity Press, 2007).