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Medicalization is the process whereby previously non-medical aspects of life come to be seen in medical terms, usually as disorders or illnesses. A wide range of phenomena has been medicalized, including normal life events (birth, death), biological processes (aging, menstruation), common human problems (learning and sexual difficulties), and forms of deviance. The medicalization of deviance thus refers to the process whereby non-normative or morally condemned appearance (obesity, unattractiveness, shortness), belief (mental disorder, racism), or conduct (drinking, gambling, sexual practices) come under medical jurisdiction.
Medicalization is a collective and political achievement that requires moral entrepreneurs who champion a medical framing of a problem. With levels and degrees we see that medicalization is not an either/or phenomenon. Nor is medicalization a one-way process. Just as deviance may become medical, the medical framing of deviance may be undone (in part or in full). As medical meaning is diluted or replaced, medical terminology and intervention are deemed inappropriate. Masturbation is the classic example of near total demedicalization; in the nineteenth century, masturbation was medicalized as ”onanism,” a disease in itself, as well as a gateway perversion that rendered those of weak constitutions more susceptible to other forms of sexual deviation. Another example is the removal of homosexuality from the third edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-III). But whereas earlier medical framing of masturbation now seems absurd to many, the reclassification of homosexuality illustrates contested demedicalization. Despite the 1973 decision by the American Psychiatric Association to remove homosexuality from the roster of mental disorders, a small but vocal psychiatric minority provides reparative or conversion therapy, and a portion of the public still views homosexuality as deviance (but not necessarily as illness). Homosexuality thus also illustrates that demedicalization does not automatically mean a form of deviance has or will become conventional, only that the official medical framing has ended.
The consequences of medicalization may be positive or negative — oftentimes both. The therapeutic ethos of medicine changes the moral status of both deviance and deviant. Extension of the sick role to the deviant diminishes stigma and culpability, both of which may increase the likelihood that a pedophile, batterer, or addict for example might seek treatment. Medical explanations for inchoate or diffuse difficulties can provide coherence to symptoms, validate and legitimate troubles, and support their self-management. In addition, medical recognition may facilitate insurance coverage of medical treatment, thereby transforming potential deviants into disease sufferers seen worthy of care and compassion.
Despite these benefits, many analysts are wary of medicalization and its potential negative consequences. The sick role, for example, may provide a ”medical excuse” for deviance; certainly, it diminishes individual responsibility. As the medical model becomes more attuned to physiological and genetic ”causes” of behavior, blame shifts from the person to the body, further displacing responsibility. Medicalization allows for the use of powerful forms of social control, such as psychoactive drugs or surgical procedures. But the guise of medical-scientific neutrality and/or a therapeutic modality means medicalization may be an insidious expansion of social control. Tendencies to individualize and depoliticize social problems are also linked to medicalization. Both obscure insight that deviance may be a reflection of or adaptation to the social organization of a situation; focus on the individual symptoms of gender identity disorder or battery, for example, deflects attention from the heteronormative gender order, gender inequality, and patriarchal values.
Medicalization appears to be on the increase, but how much depends in part on what is measured. One approach looks at the growing number of people diagnosed. Another considers the increasing number of diagnostic categories. In addition to the proliferation of categories, medicalization increases through expansion of extant categories. That is, diagnostic categories themselves may be stretched, encompassing more behavior within their bounds over time. Psychiatric categories, especially the functional disorders, seem especially prone to such expansion. The emergence of adult attention deficit hyperactivity disorder (ADHD), the extension of the uses of the PTSD diagnosis, and the widespread use of psychoactive medications like Prozac for unspecified psychological discomfort are examples of this.
References:
- Conrad, P. (1992) Medicalization and social control. Annual Review of Sociology 19: 209—32.
- Horwitz, A. (2002) Creating Mental Illness. University of Chicago Press, Chicago, IL.
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