Medicalization refers to the act of excessively defining and medically treating conditions, behaviors or attitudes.
This phenomenon has occurred when medical professionals, pharmaceutical drug manufacturers, and other relevant expert panels attempt to apply medical rationalization to situations where medical intervention may not be in the best interest of an individual.
Often, this involves broadening of the definition of sickness to encompass disorders that could be considered natural human behavior by sectors of society.
A common example is ADHD in schools. Instead of creating inclusive and differentiated learning environments that may help children with ADHD learn, it is often seen as easier to over-medicate children who appear hyperactive.
Medicalization Definition and Overview
Instances of medicalization are easily identifiable in Western society. They include ‘illnesses’ such as obesity, alcoholism, menopause, and social anxiety.
One of the psychiatrists at the forefront of research on this topic was Thomas Szasz (1920-2012). He was vehemently against the redefinition of personal or social problems as a medical condition. He believed:
“To the extent that psychiatry, medicine, and patient advocacy groups have defined certain behaviors as psychiatric diseases, the medical establishment then forms an alliance with the political state to gain power over individuals with the purpose of controlling those behaviors. The ultimate result is a therapeutic state that rules over all human behavior in the context of biomedical disease to the exclusion of any individual right or personal freedom. “(Montagne, 2008, para 4).
Coreia (2017) explains that medicalization first entered the vocabulary of social scientists to address how of medical institutions handle non-conforming behavior in society:
“The concept highlights the influence of medical regulation in daily life, which replaced previous social control institutions, namely the church and the law, in the management of deviance as explanations for human health conditions gradually changed from sin, to crime, and eventually to sickness” (para 5).
Conrad (1979) also suggested that medicalization created new social control systems in society.
“…on the most abstract level medical social control is the acceptance of a medical perspective as the dominant definition of a certain phenomenon” (p. 511-512).
In the following examples, there are likely situations where medical interventions are in the best interests of the patients. Nevertheless, systematic overprescription of medications has been argued to have occurred in the following areas:
- Medicalization of Depression: Instead of using non-pharmacological treatments like psychotherapy, lifestyle adjustments, or holistic treatments, depression is medically diagnosed and drugs are prescribed to the patient as a first option.
- Medicalization of ADHD: ADHD is immediately diagnosed, then treated with medication; social interventions or education-driven approaches are dismissed.
- Medicalization of Menopause: Although it is a normal part of the female aging process, menopause has been medicalized as a disease, which has led to medical professionals encouraging women to take hormone replacement drugs.
- Medicalization of Sleep Disorders: Rather than being treated with non-medical interventions such as lifestyle and dietary changes, in some cases, sleep disorders have become medicalized.
- Medicalization of Bad Breath: Often, bad breath can be treated through lifestyle and dietary changes. When physicians are too quick to prescribe drugs to treat the issue as a first option, they may be criticized for medicalization.
- Big Pharma Lobbying: Big Pharma can gain substantial economic benefits from medicalization. Many argue that pharmaceutical lobbying to politicians is designed to underpin and support over-medicalization so pharmaceutical companies can continue to sell their products.
- Medicalization of Normal Aging: Aging is a natural process, but in some cases, it has been medicalized. For example, age-related wrinkles are often treated with cosmetic procedures or prescription creams, rather than accepting them as a natural part of the aging process.
- Medicalization of Shyness: Shyness can be a personality trait, but it has been medicalized as social anxiety disorder, leading to pharmaceutical treatment instead of non-medical interventions like therapy or self-help techniques.
- Medicalization of Obesity: Rather than addressing the root causes of obesity through lifestyle changes and education, it is often treated firstly with weight loss drugs, surgery, and other medical interventions.
- Medicalization of Restless Leg Syndrome: Restless Leg Syndrome, which can be caused by lifestyle factors such as lack of exercise and caffeine consumption, is sometimes accused of being too-soon treated with medication rather than non-medical interventions.
- Medicalization of Acne: Acne, a common skin condition, has been medicalized with numerous prescription treatments available. Often, non-medical interventions such as improved hygiene, diet changes, and natural remedies are not given enough attention.
- Medicalization of Substance Abuse: Rather than addressing the root causes of substance abuse, such as poverty, trauma, and social issues, it is often treated with pharmaceutical interventions, such as addiction treatment drugs.
Of course, medicines are often necessary and a good choice for patients. The above are examples of conditions that have sometimes (but not always and not in every person’s situation) been over-medicalized.
Case Studies and Research Basis
1. Moynihan & Cassels (2006) – ADHD
Premise: ADHD is immediately diagnosed, then treated with medication. Social interventions or education driven approaches are too often dismissed.
The introduction of the influential, prolific book, Selling Sickness, begins:
“The marketing strategies of the world’s biggest drug com- panies now aggressively target the healthy and the well. The ups and downs of daily life have become mental disorders, common complaints are transformed into frightening conditions, and more and more ordinary people are turned into patients. With promotional campaigns that exploit our deepest fears of death, decay and disease, the $500 billion dollar pharmaceutical industry is literally changing what it means to be human”(Moynihan & Cassels, 2006, p. ix)
Moynihan & Cassels (2006) explain that the mass diagnosis of ADD (attention deficit disorder) and ADHD (attention deficit disorder) has been the root major controversy in western society.
They assert that according to those who study this phenomenon, in the decade from 1990 production of the drug Ritalin rose almost 800 per cent:
“By 2000, with under 5 per cent of the world’s population, Americans were consuming 80 per cent of the stimulants manufactured worldwide. That same year a leading scientific journal revealed a dramatic increase in the prescription of these drugs to toddlers”(p. 62).
They blame pharmaceutical companies for aggressively marketing ADD & ADHD drugs and selling it to parents as a ‘cure’ for children who have active imaginations and are energetic.
They conclude that:
“…drug companies are using a multitude of marketing tactics to influence the wider public debate, to make sure that particular view dominates” (p. 64).
2. Illich (1975) – Social Iatrogenesis
Sociologist Ivan Illich is a founder of the concept of medicalization. In his writing, Illich warned about the ways in which medical interventions often had negative social consequences.
The term Iatrogenesis comes from the Greek word meaning “originating from a physician.” According to Illich, the threshold for diagnosis of mental illness has been lowered over time.
This, he argues, has led to
“…the lowering of levels of tolerance for psychological discomfort or sadness, which brought about a steady increase of the diagnosis of depression” (Maturo, 2012).
The idea of social iatrogenesis can be used to explain the unintended, or negative after-effects, that are a result from seemingly well-intentioned social interventions. These can range from some of the consequences identified owith certain social welfare policies (e.g., dependency on government assistance, or deterioration of work ethic), or over-prescription of medications for mental health issues.
Maturo (2012) adds:
“…mental health is likely the most medicalized aspect of human life. Emotions like sadness and shyness, if framed through a pathologizing gaze, can easily be turned into illnesses”(para 14).
3. Moynihan & Cassels (2006) – Medicalized Obesity
In 2013, the American Medical Association (AMA) officially labeled obesity as a disease. They refer to obesity as a disease state with multiple functional changes that require a range of treatment and prevention options (AMA, 2013).
In the wake of this decision, the newly labeled medical condition of ‘being overweight’ has spawned a booming industry of weight loss supplements, fat trimming surgical procedures, and a variety of other medical procedures to make people thinner.
However, what Moynihan & Cassels (2006) found more appalling was the medicalization of cholesterol.
While it has been identified that high cholesterol is one of many factors that can contribute to heart disease, data has been manipulated by pharmaceutical companies for a different agenda; mainly profit.
” High cholesterol the condition has become frenzied. But one pill in particular has leapt ahead of the pack, and now commands almost half the total market—Lipitor. Racking up sales of more than $10 billion a year, Lipitor is the world’s top-selling prescription drug, ever. Its manufacturer Pfizer […] is one of the largest corporations on earth, thanks in no small part to widespread fears of high cholesterol”(Moynihan & Cassels, 2006, p.2-3).
More disturbingly, they add, is that doctors are being instructed how and what drugs to prescribe in education seminars. These seminars are often funded in venues that are sponsored by the makers of the drugs themselves.
In essence, their argument is that the integrity of doctors becomes compromised, as they become puppets for the profit focused agenda of pharmaceutical companies.
Additionally, more than 60% of biomedical research and development on these drugs has been but privately funded by pharmaceutical companies.
In the case of drugs offered for depression, it is 100% privately funded research (Moynihan & Cassels, 2006, p. 5).
4. Foucault (1988) – Madness and Civilization
Michel Foucault, famed theorist whose work underpins poststructural theory, wrote extensively of the role of scientific and medical rationalization in negatively affecting people’s lives.
Foucault’s PhD dissertation, which was turned into the book Madness and Civilization, demonstrates how the concept of madness has been addressed in different eras.
He demonstrated how in the Renaissance Era mad people were seen to be wise. In the Classical Era, they were seen as pariahs. Mad people were shunned by society. But in the Modern Era mad people were seen as sick. They have become pathologized and medicalization has been used to try to ‘fix’ them.
Criticisms and Pushback
There are three very valid criticisms of medicalization that we think need to be stated. They are:
- Underestimating the benefits of medicalization: Some people need medicines, and medicalization theory can shame them for seeking them out. Medicalization theory tends to overlook the fact that medicines are beneficial and often in the best interests of patients. Indeed, it has led to increased life expectancy and improved public health overall. Nevertheless, we can also see that it may be sometimes too rapidly chosen as a solution.
- Overgeneralization: Critics argue that medicalization theory overgeneralizes and tends to be skeptical of all uses of medicines and unfairly maligns the medical profession. The theory could be accused of ignoring the fact that many issues have been medicalized for valid medical reasons.
- Ignoring patient agency: Patients often want, seek out, and get serious benefits from medicines. Critics argue that the theory fails to account for the role that patients play in seeking medical interventions for themselves. Perhaps, medicalization isn’t a conspiracy imposed from the professions, but a choice made by rational-thinking individuals.
Medicalization is a complex and hotly debated topic. Undoubtedly, there have been many instances in which people have been too-soon medicalized in order to ‘normalize’ their behaviors. Nevertheless, the extent to which it is a systemic issue likely differs across cultures, conditions, and eras. It’s important to be very careful in considering the context of each instance, and at a societal level, making sure doctors have the right incentives for making their prescriptions.
American Medical Association. (2013). Recognition of Obesity as a Disease H-440.842. In AMA Policy Finder. https://policysearch.amaassn.org/policyfinder/detail/obesity?uri=%2FAMADoc%2FHOD.xml-0-3858.xml
Correia, T. (2017). Revisiting Medicalization: A Critique of the Assumptions of What Counts As Medical Knowledge. Frontiers in Sociology, 2. https://doi.org/10.3389/fsoc.2017.00014
Conrad, P. (1979). Types of Medical Social Control. Sociol. Health Illn. 1, 1–11. doi:10.1111/j.1467-9566.1979.tb00175.x
Foucault, M. (1988). Madness and civilization: A history of insanity in the age of reason. Vintage.
Illich, I. (1975). The medicalization of life. Journal of medical ethics, 1(2), 73-77.
Maturo, A. F. (2012). Medicalization: Current concept and future directions in a Bionic Society. Mens Sana Monographs, 10(1), 122. https://doi.org/10.4103/0973-1229.91587
Montagne M. (2008). The Medicalization of Everyday Life. Selected Essays. American Journal of Pharmaceutical Education. 72(5) p. 123. PMCID: PMC2630149.
Moynihan, R., & Cassels, A. (2006). Selling Sickness: How the World’s Biggest Pharmaceutical Companies Are Turning Us All Into Patients. Nation Books.