CAUSES OF MEDICALIZATION

Conrad is interested in the social underpinnings of the expansion of medical jurisdiction (Conrad 2007: 4). The increased impact of medicine can be seen in the increased spending on health care as well as in the increased number of physicians in our society. But Conrad pays particular attention to how nonmedical problems have entered the jurisdiction of medicine. He uses the term “medicalization” to explain the process of previously nonmedical problems becoming defined as illnesses and disorders i.e., medical problems. How do we know if a problem has entered the medical jurisdiction? Conrad suggests a few criteria. We can ask if the problem is described by medical language, interpreted with a medical framework, or treated with a medical intervention (Conrad 2007: 5).

For Conrad, medicalization comes in various degrees. For instance, conditions like death, childbirth, and several mental illnesses are more medicalized than opiate addiction or menopause are (Conrad 2007: 6). Expansion or contraction of medical categories also influences the degree of medicalization (Conrad 2007: 7). It is important to know that medicalization is bidirectional, hence medicalization and demedicalization can both occur. Demedicalization is the process of medical problems no longer being considered as medical and as requiring no medical interventions. Examples of demedicalization involve masturbation, disability, and homosexuality.

There are many factors that encourage medicalization including the waning influence of religion, growing trust in science, the increased authority of the medical profession, the American inclination for solving problems through technology, and increasing humanitarianism in western societies (Conrad 1992: 214). Conrad pays special attention to secularization and the changing roles of the medical profession. In contemporary society, medicine has taken over religion’s role as the “dominant moral ideology and social control institution.” Examples of secularization leading to medicalization include homosexuality. Reactions to religious sanctions is one of the reasons for the medicalization of homosexuality. (Conrad 1992: 214). On the other hand, medical professionals also have a strong influence in medicalization. Pediatricians extending their responsibilities from treating sick children to treating troublesome behavior is a good example to illustrate this phenomenon. One hypothesis is that pediatricians are responding to a decrease in sick children due to improved public healthcare measures. Another hypothesis is that the routinization of specialists leaves them understimulated and seeking to make their work more engaging with new pediatrics. Both hypotheses shows that medicalization is a result of intraprofessional issues (Conrad 1992: 216).

Conrad argues the forces of medicalization include not only the medical profession but also social movements and the healthcare and pharmaceutical industries (Conrad 2007: 6). Patients and laypeople can also promote and shape their diagnoses through collective action (Conrad 2007: 9). For example, the women’s movement helped to establish premenstrual syndrome or PMS as a new medical category. Pharmaceutical innovations can also contribute to medicalization. We can see this in how hormone replacement therapy intensified the medicalization of menopause (Conrad 2007: 10).

CONSEQUENCES OF MEDICALIZATION

Conrad argues medicalization presents some social benefits (Conrad 2007: 147). First, through extending the “sick role” to many ailments, individuals no longer receive blame for a number of problems beyond their control. Since the stigma on conditions such as alcoholism and anorexia is reduced, people are able to receive the support they need. Second, medicalization provides real reductions to suffering by way of pain medications, extended mortality, and more. Third, biomedical enhancement interventions (e.g., plastic surgery) can give people more self-esteem or better life opportunities beyond narrow concerns of “health” (Conrad 2007: 148).

These benefits, however, do not outweigh other darker consequences of medicalization. The first concern is that of pathologizing everything (Conrad 2007: 148). Many human differences, from learning styles to the amount of hair on our heads, have become problems requiring treatment or enhancement. Where could this trend lead us? The inability to tolerate human differences may also hinder our ability to celebrate human diversity.

The second concern is medical definitions of normality (Conrad 2007: 149). Through promoting diagnoses or creating standards for treatment, the pharmaceutical industry has significant power to define what is normal or abnormal (Conrad 2007: 150). The scary part is that companies have business incentives to create and define “norms” or “abnorms” in our society.

The third concern is the expansion of medical social control (Conrad 2007: 151). Medical expectations have become the standard for people’s behavior. For instance, pregnant women cannot consume any alcohol without judgement from strangers as the public has become aware of fetal alcohol syndrome. Another form of medical social control is that even healthy people have become objects of medical interest due to their risk for future disease. People monitor their blood pressure and cholesterol to prevent themselves from getting strokes or heart disease. Using pharmaceuticals or surgeries to alter human behavior or mood is another sign of medical social control. These drugs and medical interventions exist because people’s problems have been medicalized.

The fourth concern is the narrow focus on individuals rather than on social context (Conrad 2007: 152). Medicalization leads to people solving medical problems in individual people instead of solving problems in society. People try to treat children with ADHD instead of enhancing the school system. Medicalization can prevent us from seeing social causes of problems and can reinforce an individualized approach to solving social problems.

The last concern is the emergence of patients as consumers and the development of medical markets (Conrad 2007: 153). Pharmaceutical and biotechnology companies’ marketing of medical diagnoses and medical solutions has transformed patients into consumers. Patients can purchase doctors’ services after seeing advertisements from magazines or websites. Hence, consumers and medical entrepreneurs become important players in medicalization. Consumers can request the medication they see in advertisements from their doctors. They can also purchase medical products and services in private markets. They even self-diagnose and seek treatment from doctors. The medical industry’s marketing and consumers’ purchasing are major forces in medicalization.

WEBER TO CONRAD

Weber would call medicalization a form of rationalization. He would say medicalization is society moving away from traditionalism. Weber believes that there are three types of authority: authority based on rational grounds, authority based on traditional grounds, and authority based on charismatic grounds (Weber 1922: 215). He would view medical authority as a type of rational authority and religious authority as a type of traditional authority. Medical authority is rational authority because people have a belief in modern biomedicine. People trust their doctors and nurses because medical professionals exercise medicine. Patients do not have personal loyalty toward the people who treat them (Weber 1922: 215). When people look for solutions to their daily problems in religious activities, it is a result of traditional authority. When people look for solutions in medicine instead of religion, it reflects a shift from traditional authority to rational authority in society. Weber would say that people’s faith in doctors is a result of bureaucratization. People’s trust in medical professionals stems from their perception of the doctor as a “detached and strictly objective expert” (Weber 1922: 975).

Weber would see the decline of religion as inevitable because religion has leaked out of his iron cage metaphor. He uses the iron cage to describe the society in modern rational capitalism in which religious asceticism has escaped (Weber 1905: 181). The religious element fades out, and only the spirit of capitalism, making money for the sake of making money and working for the sake of working, remains (Weber 1905: 180). Hence, he would say the expansion of medical jurisdiction and the decline of religious authority is an inevitable byproduct of rationalization.

Weber would also see Conrad’s concern for the expansion of medical social control as part of the iron cage. Workers work for the sake of working, doctors diagnose for the sake of diagnosing, and patients get treatment for the sake of treatment. Pediatricians are supposed to treat sick children. When there are fewer sick children, they should do less work. However, when they realize there are fewer sick children, they actually expand their practice to treat troublesome behavior. On the hand, people should go to doctors when they are sick. If they are not sick, they should not go to doctors. But people not only go to doctors for diagnosis and treatment but also for prevention and enhancement.

CONRAD TO WEBER

Conrad would agree that when medicine replaces religion as a social control institution, it is rationalization. In fact, he cites Turner and calls this process “a piece with the rationalization of society” (Conrad 2007: 214). But he will also argue that it is important to not simply understand medicalization as rationalization. For instance, things that used to be controlled by law can fall under the jurisdiction of medicine as well. When a cause of a crime has a biological explanation, then the person who committed the crime has a medical excuse. Since the person can longer be held accountable for the crime, society’s response also switches from punishment to therapy (Conrad 2007: 152). In this way, medicalization can also be an infringement on legal authority, which cannot be explained by rationalization.

Conrad would also remind us that demedicalization and resistance to medicalization also exist and they may complicate the trend of rationalization. For instance, LGBTQ movements have changed the definition of homosexuality from an illness to an orientation (Conrad 2007: 157). What should we make of the demedicalization of homosexuality using the concept of rational authority? The movement challenged rather than embraced rational authority. Another example is the natural birth movement resisting the medicalization of birth. Although birth has not been demedicalized, some women choose to have fewer medical interventions during birth and some even chose home birth (Conrad 2007: 158). When mothers opt for less medicalized childbirth, their resistance suggests a move away from rational legal authority.

CONCLUSION

One of the limitations of Conrad’s theory is that even though he sees medicalization as a process, he believes that there is a minimum threshold for determining whether a practice is medicalized or demedicalized (Torres 2014: 160). Conrad argues that birth is not demedicalized unless birth is not attended by doctors (2007:225). However, this kind of criteria makes it difficult to account for changes in birth practices such as the presence of home births and doulas. If we move the attention away from determining whether something is demedicalized or medicalized and focus on whether there is an increase or decrease of medicalization or demedicalization, we will be able to better describe the complexity of events and document the instances where medicalization and demedicalization coexist (Torres 2014: 160).

Another limitation is that medicalization may need to continuously expand its definition to account for changes in society. Scholars have invented terms such as "biomedicalization" and "camisation" to describe phenomena that are slightly different from the original definition of medicalization (Clark et al. 2003: 163; Almeida 2012: 25). Biomedicalization is an extension of medicalization that differs in its emphasis on the biopolitical economy and on enhancements of human bodies due to the development of techno biomedicine (Clark et al. 2003:163). Camisation is the process of everyday problems being treated with complementary and alternative medicine (Almeida 2012:25). These new definitions and theories build upon medicalization by accounting for certain new trends in society not delineated in the original medicalization literature.

Despite the limitations, it is still important to read Conrad’s work. Most importantly, it suggests a unique way to interpret changes in medicine and society. It manages to bring research on seemingly unrelated events such as alcoholism and ADHD under one frame. When new phenomena emerge, researchers can use medicalization as a tool to study them. On the other hand, Conrad also encourages us to see the many dark consequences of medicalization. This is especially useful for students who want to work in the medical industry. When medical professionals become aware of their impact, they will be able to make conscious decisions in their practices. Hence, problems such as overmedicalization may decrease. Also, medicalization is still relevant to our society and cannot be simply replaced by biomedicalization. It would be difficult for students to understand concept of biomedicalization without familiarity with medicalization anyway.

REFERENCES

Almeida, Joana. 2012. “Towards the Camisation of Health? The Countervailing Power of Cam in Relation to the Portuguese Mainstream Healthcare System.” ProQuest Dissertations Publishing.

Clark, Adele E., Janet K. Shim, Laura Mamo, Jennifer Ruth Fosket, and Jennifer R. Fishman. 2003. “Biomedicalization: Technoscientific Transformations of Health, Illness, and U.S. Biomedicine.” American Sociological Review 68(2):161–94.

Conrad, Peter. 2007. The Medicalization of Society: On the Transformation of Human Conditions into Treatable Disorders. Baltimore: Johns Hopkins University Press.

Conrad, Peter. 1992. “Medicalization and Social Control.” Annual Review of Sociology 18:209–32.

Conrad, Peter. 2017. “It Takes a Village: Reflections of a Life in Sociology.” Sociology Newsletter 2018. https://www.brandeis.edu/sociology/pdfs/newsletter-final-2018.pdf

Torres, Jennifer M. C. 2014. “Medicalizing to Demedicalize: Lactation Consultants and the (de)Medicalization of Breastfeeding.” Social Science & Medicine 100:159–66. doi: 10.1016/j.socscimed.2013.11.013.

Weber, Max. 1922. Economy and Society. Berkeley: University of California Press.

Weber. 1905. The Protestant Ethic and the Spirit of Capitalism. Dover Publications.