Medicalization


Definition


Medicalization is a social process through which a previously normal human condition (behavioral, physiological or emotional) becomes a medical problem in need of treatment under the jurisdiction of medical professionals. The process of medicalization is based on the biomedical model of disease, one that sees behaviors, conditions, or illnesses "as a direct result of malfunctions within the human body" [1] and requiring biomedical oversight in Western culture.
Thus, medicalization changes ones understanding of a specific condition from a variant upon human social nature to a deviation from normal biological functioning, something that can be treated through the use of biomedicine. Often times this change is achieved through the labels of illness, disease, or disorder. [2]





History


The ideas behind the concept of medicalization has their beginnings with Michel Foucault and Ivan Illich.
The term medicalization entered academic and medical publications in the 1970s, most notably in the works of figures such as Irving Zola, Peter Conrad and Thomas Szasz. They argued that the expansion 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.
Increasingly sophisticated medical technology had extended the potential of this type of social control. Ivan Illich in "Limits to medicine: Medical nemesis" (1975) influentially made one of the earliest uses of the term "medicalization". Illich, a philosopher, argued that the medical profession actually harms people in a process known as iatrogenesis, where there is an increase in illness and social problems as a result of medical intervention. Illich saw this occurring on three levels: the clinical, which involves serious side-effects that are often worse than the original condition; the social, whereby the general public is made docile and reliant on the medical profession to help them cope with their life in their society; or the structural, whereby Western medicine's notion of issues of healing, aging and dying as medical illnesses effectively "medicalized" human life, rendering individuals and societies less able to deal with these "natural" processes.
Illich's assessment of professional medicine, and particularly his use of the term medicalization, quickly caught on, as critiques of the expansive categories of illness and health appeared throughout a vast array of professional literature throughout the 1970s and 1980s.[3]





Benefits


Many argue that the process of medicalization does bring health benefits for millions of individuals around the world. One such benefit is that, in recognizing a condition as a disease or disorder, certain conditions can be treated that affect the experience and quality of life. One example of this is the medicalization of Alzheimer's, a previously neglected disease that was often associated with senility[4] . It is now classified as a mental illness and can be treated using biomedical drugs. In addition, classifying an individual as suffering from some type of biological malfunction may provide relief from feelings of ostracism, for it gives them an objective explanation as to why they may be or feel different from what is "normal."





Critiques


On the other hand, the process of medicalization also faces much criticism from those who are wary about the increasing jurisdiction of the biomedical profession. One such criticism is that the biomedical profession is intruding upon the experience of everyday life, and is doing so to increase its profit in the drug industry. Studies show that with the appearance of new diseases come new drugs as well, and thus a more profitable market for drug companies.
In addition, the label of disease or illness may attach a stigma to the individual being labeled, increasing the individual's experience of life as "sick" or "disordered." Shyness, for example, has been recently categorized under the umbrella of a variety of disorders, including "avoidant personality disorder," a label which may negatively affect self-perception[5] . Furthermore, medicalization has been criticized as a form of social constructionism, a perspective that considers "reality and knowledge as socially constructed" . Thus, in this light, it is the authority of certain social institutions, rather that the objectivism of nature, that determines what is truly defined as disease or health.





Case Studies


Medicalization has occurred in both deviant behavior and "natural life processes." ==
Examples of medicalized deviance include: alcoholism, homosexuality, hyperactivity and learning disabilities in children, eating problems, infertility, and more.
Examples of medicalized "natural life processes" include: sexuality, childbirth, pre-menstrual syndrome (PMS), menopause, aging and dying, among others.[6]





Childhood and Behavioral Disorders

One area that has seen increased medicalization in recent years is the area of child behavior. Some argue that the boundaries of what used to be considered normal child behavior are being medicalized, resulting in skyrocketing numbers of children being diagnosed with ADHD, or attention deficit hyperactivity disorder[7] . Before the diagnosis of ADHD, most of these children would have simply been seen as particularly hyper, or as having trouble focusing in school, not as having a biological disorder which could be treated using a variety of different medicines.
Dr. David E. Arredondo presents one side of the argument against the medicalization of child behavior, discussing the negative effects that the increase in biomedical drugs can have on children:






Male Sexual Dysfunction

Erectile dysfunction, previously associated with elderly men, is in the inability to achieve or maintain an erection. This can also be caused by stress, anxiety and depression or the use of certain medications, and more and more younger men are now taking Viagra to treat ED. While this syndrome is rarely talked about in other cultures, the proliferation of Viagra has been promoted worldwide with an emphasis on "performance" and creates new standards for what constitutes "normal" male sexual function across the life cycle.[8]





Pregnancy and Childbirth

Increasingly, the state of pregnancy has been medicalized, especially in the United States. Pregnant women are urged to seek care from a doctor numerous times throughout pregnancy (as part of routine prenatal care), including scheduled blood tests and ultrasounds. There is advocacy, too, for women to visit a medical provider before pregnancy occurs. Media for women who are or who wish to become pregnant, such as the book What to Expect When You are Expecting,[9] repeat the message that although pregnancy is a natural state, ideally, it should be monitored biomedically. According to kidshealth.org, “Almost 4 million American women give birth every year, says the Centers for Disease Control and Prevention (CDC). Nearly one third of them will have some kind of pregnancy-related complication. Those who don't get adequate prenatal care run the risk that such complications will go undetected or won't be dealt with soon enough. That, in turn, can lead to potentially serious consequences for both the mother and her baby. These statistics aren't meant to be alarming, but to convey the importance of starting prenatal care as early as possible — ideally, before a woman even becomes pregnant.”[10]

Erickson reported in 2003 that the number of ultrasounds a pregnant woman receives varies across Western countries, from an average of seven in Germany to one or two in the United States[11] , while more recent research found that the number of ultrasounds during pregnancy have increased, from an average of 1.5 in 1995-97 to 2.7 in 2005-06, with women in high-risk pregnancies receiving an average of 4.2 ultrasounds in 2005-06, up from 2.2 in 1995-97[12] .

Recently, the use of multiple ultrasounds during pregnancy has generated attention, both from advances in technology that allow expectant parents to view a 3-D image of their fetus to concerns over the possible negative health implications of ultrasounds.[13]

external image Ultrasound3D.jpg


Births are expected to take place at a hospital, and doctors may facilitate the process using drugs and procedures, relatively recent phenomena that have not existed for most of the births that have taken place in human history.

Over 98 percent of births in America occur in a hospital. Despite these highly technologized births, the U.S. now has the highest number of maternal deaths relative to all other high-income nations, and we also rank second worst for perinatal deaths.[14] The medicalization and technologization of childbirth has not improved overall birth outcomes.
Medical Anthropologist Robbie Davis-Floyd has critiqued the medicalization of childbirth: "Routine electronic fetal monitoring remains pervasive, even though it does not improve outcomes but does raise the incidence of unnecessary cesareans. Induction of labor increases prematurity rates and labor complications, but its use has skyrocketed in the past decade to more than 53 percent. Epidurals can slow labor, generate fevers, and necessitate further interventions for both mother and baby (who will end up in the NICU if the mother does develop a fever). Cesareans generate higher rates of infection and other complications (including death) than vaginal birth, but the cesarean rate in the U.S. is at an all-time high of 32 percent."[15]
To view how childbirth practices have changed over time, view the video below, Changes in Birth Practices:
Video clips and images on how the lithotomy position (laying on your back) came about, when men got involved in birth, birth preparations in the 1930's, midwives in low-income populations in the south, midwives delivering fewer and fewer babies in the U.S. as birth moved to hospitals.






Women's Health

Menstruation and PMS (pre-menstrual syndrome) have become medicalized, especially in Western society. Hormone contraceptives are used to control the menstrual cycle or culturally-subjective experiences of PMS. "Standard dosages of oral contraceptives may be inappropriate for women with lower baseline levels of estrogen and progesterone," for instance in women from subsistence populations such as Zaire, Bolivia and Nepal, and are likely associated with increased rates of negative side effects from oral contraception. Furthermore, PMS is not universally recognized; "it is less frequently noted in more traditional societies where menstruation is more often perceived as a sign of health, youth, fertility, and femininity than in the United States and European countries."[16]
Biomedical views of menopause tend to pathologize menopause, even though the cessation of ovulation is part of the normal life cycle. In Biomedicine, menopause is considered a "estrogen deficiency disease" due to "ovarian failure" and "treated" with hormone replacement therapy. Hormone replacement therapy, however, has serious side effects, such as an increased risk for cardiovascular disease and breast cancer. Cross-cultural studies have found that symptoms of menopause vary. For instance, Lock's study of menopausal women in Japan found that they did not experience the same symptoms that Western biomedicine considers standard, such as hot flashes, headaches, melancholy, etc.[17]





Related Terms

Biomedicine





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Resources




Medicalization and Social Control by Peter Conrad

Articles on Medicalization of Childbirth by Robbie Davis-Floyd





Works Cited


  1. ^
    Beard, Ren . "Medicalization of Aging." Encyclopedia of Aging. 2002. Encyclopedia.com. accessed 26 Apr. 2010 <http://www.encyclopedia.com >
  2. ^
    Marshall, Gordon. "Medicalization." A Dictionary of Sociology. 1998. Encyclopedia.com. accessed 26 April 2010 <http://www.encyclopedia.com/doc/1O88-medicalization.html >
  3. ^
    Illitch, Ivan. "Development of the Concept" Medicalization. Wikipedia.org. accessed 15 Sept 2010
  4. ^
    Ireland, Corydon. "Scholars Discuss ‘medicalization’ of Formerly Normal Characteristics." Harvard Gazette 28 Apr. 2009. Print.
  5. ^
    Ireland, Corydon. "Scholars Discuss ‘medicalization’ of Formerly Normal Characteristics." Harvard Gazette 28 Apr. 2009. Print.
  6. ^
    Conrad, Peter. "Medicalization and Social Control." Annual Review of Sociology 18 (1992): 209-32. http://www.jstor.org/stable/2083452?seq=1
  7. ^
    Wiley, Andrea S., and John S. Allen. Medical Anthropology: A Biocultural Approach. New York: Oxford UP, 2009.
  8. ^ Type the content of your reference here.
  9. ^
    Murkoff, Heidi, and Sharon Mazel (2008). What to Expect When You Are Expecting. Workman Publishing Company: New York.
  10. ^ KidsHealth.org. Medical Care during Pregnancy (2011). http://kidshealth.org/parent/pregnancy_center/your_pregnancy/medical_care_pregnancy.html#.
  11. ^
    Erikson, Susan L. (2003) Post-Diagnostic Abortion in Germany. Social Science and Medicine 56:1987-2001.
  12. ^ Siddique, Juned, DS Lauderdale, TJ VanderWeele, and JD Lantos (2009). Trends in Prenatal Ultrasound Use in the United States: 1995 to 2006. Medical Care 47 (11) 1129–35.
  13. ^
    Rodgers, Caroline (2006). Questions About Prenatal Ultrasound and the Alarming Increase in Autism. Midwifery Today 80 (Winter issue).
  14. ^
    Cheyney, Melissa. "Why Home Births Are Worth Considering" Huffington Post. 9 Sept 2010.
  15. ^
    Davis-Floyd, Robbie. "Anthropology and Birth Activism: What do we Know" in Anthropology News (2005) 46(5):37-38.
  16. ^ Wiley, Andrea S. and John S. Allen. Medical Anthropology: A Biocultural Approach. New York: Oxford UP, 2009.
  17. ^
    Lock, M and Nguyen, V. "Local Biologies and Human Difference" In: An Anthropology of Biomedicine. 2010