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HGA339 Minor Essay

In the form of an essay, discuss the concept of medicalization (and if appropriate de-medicalisation) and some of the possible consequences of medicalization using one example of medicalization.

The medicalization of deviance Ch12 textbook

Medicalisation is the process by which non-medical problems become defined and treated as medical issues, usually in terms of illnesses, disorders, or syndromes.1 Read the scope of psychiatric influence heading

Lecture slides
Medicalisation consists of defining a problem [not previously seen as medical] in medical terms, using medical language to describe a problem, adopting a medical framework to understand a problem, or using medical intervention to treat it.2 At a conceptual level medicalisation entails defining problems through medical vocabulary. Institutionallevel medicalisation occurs when organisations adopt medical approaches to treating particular problems. At an interactional level, physicians may medically diagnose a patients problems or offer medical treatment (e.g. tranquilisers for a social problem such as an unhappy family life or grief).3 Benefits of medicalization: medical treatments can remove/reduce suffering. Individuals and groups can also benefit from medicalisation in so far as being ill is generally viewed more sympathetically than being sinful or bad, for example: in alcoholism, the process of medicalisation removes culpability: a persons problems can be ascribed to a chemical imbalance rather than as reflecting his or her character or accomplishments. Critiques 1. Pathologise everyday life. Zola (1972) argued if anything can be shown in some way to affect the workings of the body and to a lesser extent the mind then it can be labeled an illness itself or jurisdictionally a medical problem. Thus even normal physical conditions such as menstruation, pregnancy and childbirth, body and facial shape and size, ageing and sexuality have been brought under medicines jurisdiction. 2. Emphasize individual rather than social causes for problems.

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Textbook 243 Conrad 1992:211 3 Carpenter 2010: 614

3. Medicalisation and economic interests. Part of the sociological critique of medicalisation is focused on the possible alignment between the medical profession, medicalisation and the economic interests of pharmaceutical and biotechnology companies. 4. Iatrogenesis. Medicalisation may lead to increased iatrogenesis. Iatrogenesis is defined as the development of new health problems as the result of treatment for existing health problems. Xanax addiction. Ivan Illich 1974 claimed that medical practice was a threat to health, identified a syndrome he called medical nemesis or iatrogenesis. Depression, infection, disability, dysfunction, and other specific iatrogenic diseases now cause more suffering than accidents (1974:74). 5. Concern about the increasing power of medicine. Social control 6. Narrowing range of normal. The range of behaviours viewed as desirable or normal is narrowed. This reflects the attitudes and priorities of dominant social groups. Individuals or groups who fall outside of dominant categories of normal/desirable are particularly culnerable to medicalisation. 7. Medicalisation and gender De-medicalisation

Pill popping phenomenon

Pill for any ill healthcare. Modern-day examples of classified disorders that have been taken from the realm of everyday life include gambling, smoking, over-eating, Attention Deficit Hyperactiviy Disorder (ADHD), hair loss, sexual dysfunction, obesity, snoring, acne, Post Traumatic Stress Syndrome (PTSS) and the list goes on.4
People still have a choice as to whether they wish to seek doctor assistance for a particular diagnosis or engage in medicating. But throughout history, influencing factors have provided powerful enticement to sway society the medical way, and this still happens today. The history of medicalisation Medicalisation is a 'historical trend rather than an event' (Golden, 1999, p. 2). But the concept of medicalisation only entered medical parlance in the early 1970s with the theories of Eliot Friedson, Irving Zola, and Ivan Illich, renowned sociologists; Zola is perhaps the father of the concept (Conrad, 2007) . Since then, medical professionals have identified a number of problems and recognised them as illnesses or disorders; this has impacted hugely on individuals and society as a whole. The power of medical professionals, especially that of doctors, can be traced back to the roots of modern medicine, and the subsequent rise of 5 qualified physicians.

Draw on Foucault here -> In modern times, those who possess knowledge and potent communication skills can exert power over others, and Western societies dependence on medical expertise deprives the layperson of their ability to cope with their own problems (Nettle ton, 2006; Wilkinson &Miers, 1999;
Zelek &Phillips, 2003). Given doctors power and their control over the medical affairs of their patients, one can begin to see how medicalisation has become such a powerful force. It has been suggested that simply medicalising unhappiness, as evidenced by the over-prescription of antidepressants, reflects a

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Pill popping 25 Pill popping 25

societal need for a quick fix and a lack of a clear definition for mental disorders (Dworkin, 2001; Horwitz &Wakefield, 2007; Kirsch et al., 2008; Parker, 2007).

Medicalisation: A Multi-Dimensional Concept

We suggest that some earlier accounts of medicalisation over-emphasized the medical professions imperialistic tendencies and often underplayed the benefits of medicine.6 as we enter a post-modern era, conceptualizing medicalisation as a uni-dimensional, uniform process or as the result of medical dominance alone is clearly insufficient. Indeed, if, as Conrad and Schneider (1992) suggested, medicalisation was linked to the rise of rationalism and science (ie to modernity), and if we are experiencing the passing of modernity, we might expect to see a decrease in medicalisation.7
Originally, the concept was strongly associated with the notion of medical dominance; with a general trend towards medicalisation being causally linked to the medical p rofessions apparently inexorably 8 increasing cultural and social authority. For Zola and Conrad, medicalisation was the product as well as the cause of societal faith in medical 9 knowledge and practice. Thus, at the turn of the 21 century, far from their being an inexorable trend towards medicalisation, there 10 seems to be oscillation between medicalisation and demedicalisation of many aspects of everyday life.

Depression and the medicalisation of sadness

According to the World Health Organization (WHO), depression will be the second biggest disease burden by 2020 (Murray & Lopez, 1996).11 It is being argued that the current diagnostic criteria for diagnosing depressive disorder (since the DSKIII, in 1980) do not differentiate between abnormal sadness due to internal dysfunction or depression (sadness without an identifiable cause) and normal sadness (sadness with a clear cause) (Horwitz & Wakefield, 2007). While some state that the current DSM definition of depression wrongly encompasses an natural reaction to life events rather than a mental disorder (Horwitz & Wakefield, 2007; Parker, 2007), others defend the diagnostic criteria, raising concerns about people still being undiagnosed who are missing out on treatment (Hickie, 2007; Pies, 2009; Royal College of Psychiatrists, 1992).12 *Australia beyond blue posters eg*
There is an important exclusion clause in the diagnostic criteria for depressive disorder: people presenting with depressive symptoms are exempt from being diagnosed if they are suffering due to the death of a loved one. In this instance, attention is paid to the context of the symptoms being seen as a normal human response. Horwitz
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Multi dimensional 228 Multi dimensional 228 8 Multi dimensional 229 9 Multi dimensional 237 10 Multi dimensional 238 11 Medicalization of sadness 165 12 Medicalization of sadness 165

and Wakefield (2007) propose that besides bereavement, there are many other types of loss and adverse events 13 that can trigger deep but normal sadness that also need to be taken into account.

Medicalization and Social Control

Medicalization describes a process by which nonmedical problems become defined and treated as medical problems, usually in terms of illnesses or disorders.14 Although much has been written about medicalization, the definition has not always been clearly articulated. Most agree that medicalization pertains to the process and outcome of human problems entering the jurisdiction of the medical profession, but there are differences in the way they see the process. One of the most straightforward definitions is presented by Zola (1983:295): Medicalization is a process whereby more and more of everyday life has come under medical dominion, influence and supervision. In an early statement, Conrad (1975:12) sees it as defining behavior as a medical problem or illness and mandating or licensing the medical profession to provide some type of treatment for it.15 Read more on critiques here Social constructionism16 Although medical imperialism cannot be deemed the central explanation for medicalization (Zola 1972, Conrad & Schneider, 1980b), the organization and structure of the medical profession has an important impact.17 Medical surveillance - Based on the work of Foucault (1973, 1977), this form of medical social control suggests that certain conditions or behaviours become perceived through a medical gaze and that physicians may legitimately lay claim to all activities concerning the condition.18 Consequences of medicalization Conrad & Schneider (1980a:245-52) separate the consequences into the brighter and darker sides. Like most sociologists, they emphasize the darker side: assumption of medical moral neutrality, domination by experts, individualization of social problems, depoliticization of behavior, dislocation of responsibility, using powerful medical technologies, and the exclusion of evil.19 The criticism of medicalization fundamentally rests on the sociological concern with how the medical model decontextualizes social problems, and collaterally, puts them under medical control. This process individualizes what might be otherwise seen as collective social problems.20

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Medicalization of sadness 166 Social control 209 15 Social control 210 16 Social control 212 17 Social control 214 18 Social control 216 19 Social control 223 20 Social control 223-224

In general, sociologists remain skeptical about medicalization, although ambivalent in the recognition of certain gains and losses (Riessman 1983).21 It may now be the right moment to focus more directly on investigating the structural underpinnings of medicalization, especially given the enormous changes occurring in medical organization and knowledge, and to expand our lens to examine cross-cultural dimensions of medicalization.22

An epidemic of depression
I argue that major depression is not a natural entity and does not identify a homogenous group of patients. The apparent increase in major depression results from: confusing those who are ill with those who share their symptoms; the surveying of symptoms out of context; the benefits that accrue from such a diagnosis to drug companies, researchers, and clinicians; and changing social constructions around sadness and distress.23 Health care systems are criticized for failing to provide even minimally adequate treatment for the majority of individuals who suffer from depression (Sanderson et al. 2003).24 Mental illness may be a reconceptualization of what, in other eras, would have been seen as weakness, bad habits, or sin.25 The American Psychiatric Associations Diagnostic and Statistical Manual (DSMIV) concept of major depression is regarded as an expression of medical naturalism (APA 1990). DSM-IV presents depression as a distinct and recognizable medical syndrome. It lists nine symptoms of which five or more-including depressed mood and/or anhedonia-must be present during the same two-week period. Individuals are either diagnosed with major depression or they are not. While the general introduction to DSM-IV concedes that all its illness definitons are human constructions (p. xxxi), most mental health workers view depression as a specific mental illness, a natural entity rather than an arbitrary construction.26
THE INCIDENCE OF MAJOR DEPRESSION Epidemiological studies consistently report that DSM major depression has increased markedly during the latter half of the 20th century. Successive population cohorts since World War II have reported increasing rates of depression and earlier onset of the illness (Weissman et al. 1996). Depression is now considered a major public health challenge affecting around 15% of men and 24% of women (Hirschfeld et al. 1997).The World Health Organization (2007) estimates that by 2020 27 depression will be second in the International Burden of Disease ranking. There are four principle explanations for this. The first is that there is an epidemic of the illness major depression. The second explanation is that the depression epidemic is an artifact related to the DSM criteria.*read more here*
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Social control 224 Social control 228 23 Epidemic 238 24 Epidemic 238 25 Epidemic 239 26 Epidemic 239 27 Epidemic 240

The third explanation is that those with incentives, particularly financial ones, have elevated rates of major depression because it serves their interests. These incentives are particularly powerful for drug companies to improve their sales and profits. Drug companies attempt to expand their market for depression as for all medical illnesses, and they sponsor depression awareness campaigns, medical education, depression carer meetings, and conferences. This may be seen as effectively giving important information to the public and doing great good, or alternatively, as largely self-serving. Drug companies 28 also clearly influence the prescribing habits of doctors (Lexchin 1993; Wazana 2000). The fourth explanation returns to the debate around conceptualizing psychopathology. This viewpoint considers the increase in depression to be a social construction, with the symptoms of depression residing in the cultural rules defining what is normal and abnormal, and the rules varying in different historical eras. At present, lack of motivation, low energy, unproductivity, and persistent unhappiness are th th conceptualized as illness. In the 18 and 19 centuries, however, similar symptoms may have been 29 conceptualized as somatic or social ailments. The social constructionist argument is difficult to develop Inappropriate medicalization may help feed unhealthy obsessions with health. Illness models tend to focus on individualized, pharmacological, and private solutions rather than sociological or political 30 explanations for health problems (Moynihan, Heath, and Henry 2002).

Essay Plan
Intro P1. Definition, history background P2. Medicalisation of sadness/depression P3. Focus on Pharmaceuticals Conclusion

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Epidemic 240-241 Epidemic 241 30 Epiedemic 242