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Medicalisation: A Multi-Dimensional Concept

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Abstract

Originally, the concept of medicalisation was strongly associated with medical dominance, involving the extension of medicine's jurisdiction over erstwhile 'normal' life events and experiences. More recently, however, this view of a docile lay populace, in thrall to expansionist medicine, has been challenged. Thus, as we enter a post-modern era, with increased concerns over risk and a decline in the trust of expert authority, many sociologists argue that the modern day 'consumer' of healthcare plays an active role in bringing about or resisting medicalisation. Such participation, however, can be problematic as healthcare consumers become increasingly aware of the risks and uncertainty surrounding many medical choices. The emergence of the modern day consumer not only raises questions about the notion of medicalisation as a uni-dimensional concept, but also requires consideration of the specific social contexts in which medicalisation occurs. In this paper, we describe how the concept of medicalisation is presented in the literature, outlining different accounts of agency that shape the process. We suggest that some earlier accounts of medicalisation over-emphasized the medical profession's imperialistic tendencies and often underplayed the benefits of medicine. With consideration of the social context in which medicalisation, or its converse, arises, we argue that medicalisation is a much more complex, ambiguous, and contested process than the 'medicalisation thesis' of the 1970s implied. In particular, 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..
CONCEPTS
Medicalisation: A Multi-dimensional
Concept
KAREN BALLARD
a
& MARY ANN ELSTON
b
a
Postgraduate Medical School, University of Surrey, Stirling House, Surrey Research
Park, Guildford, Surrey GU2 7DJ, UK. E-mail: k.ballard@surrey.ac.uk
b
Department of Health and Social Care and Political Sciences, Royal Holloway,
University of London, Egham, Surrey TW20 0EX, UK.
Originally, the concept of medicalisation was strongly associated with medical
dominance, involving the extension of medicine’s jurisdiction over erstwhile ‘normal
life events and experiences. More recently, however, this view of a docile lay populace, in
thrall to expansionist medicine, has been challenged. Thus, as we enter a post-modern
era, with increased concerns over risk and a decline in the trust of expert authority, many
sociologists argue that the modern day ‘consumer’ of healthcare plays an active role in
bringing about or resisting medicalisation. Such participation, however, can be
problematic as healthcare consumers become increasingly aware of the risks and
uncertainty surrounding many medical choices. The emergence of the modern day
consumer not only raises questions about the notion of medicalisation as a uni-
dimensional concept, but also requires consideration of the specific social contexts in
which medicalisation occurs. In this paper, we describe how the concept of
medicalisation is presented in the literature, outlining different accounts of agency
that shape the process. We suggest that some earlier accounts of medicalisation over-
emphasized the medical profession’s imperialistic tendencies and often underplayed the
benefits of medicine. With consideration of the social context in which medicalisation,
or its converse, arises, we argue that medicalisation is a much more complex,
ambiguous, and contested process than the ‘medicalisation thesis’ of the 1970s implied.
In particular, 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.
Social Theory & Health (2005) 3, 228–241. doi:10.1057/palgrave.sth.8700053
Keywords: medicalisation; medical imperialism; consumer of healthcare; social
context of medicalisation
Social Theory & Health, 2005, 3, (228–241)
r 2005 Palgrave Macmillan Ltd All rights reserved. 1477-8211/05 $30.00
www.palgrave-journals.com/sth
INTRODUCTION
The concept of medicalisation has been widely employed by social scientists,
over the last three decades, to refer to the processes by which social
phenomena come to be perceived and treated as illnesses. ‘Classic’ examples
of medicalisation described by sociologists include both deviant behaviours,
such as recurrent excess alcohol consumption (Schneider, 1978) and
hyperactivity in children (Conrad, 1975), and natural body processes, such
as ageing (Zola, 1991), pregnancy (Oakley, 1984) menopause (McCrea, 1983)
and death (Clarke, 2002). Although particularly associated with medical
sociology, the concept has been used in other academic disciplines, including
the biomedical sciences, law, and ethics, with authors identifying a diverse
range of behaviours and conditions as having been medicalised. For example,
Cermark (1998) suggests that marijuana consumption has been medicalised
through its legal use for medical purposes. It has also been argued that
so-called compulsive buying has been medicalised through the use of
medication and cognitive behavioural therapy to control this behaviour (Lee
and Mysyk, 2004).
Originally, the concept was strongly associated with the notion of medical
dominance; with a general trend towards medicalisation being causally linked
to the medical profession’s apparently inexorably increasing cultural and
social authority. Latterly, however, the idea of a docile lay populace, in thrall
to expansionist medicine, has been questioned by many medical sociologists.
Thus, it is suggested that increased concerns over risks, both health and non-
health related, and the challenging of expert authority and scientific
knowledge, has led to a modern day ‘consumer’ of healthcare who is seen
as playing an active role in bringing about or resisting medicalisation. This
has led to the need for closer consideration of the specific social contexts in
which the different dimensions of medicalisation arise, and for further
clarification of how the concept can be used to describe social phenomena.
Moreover, as sociological attention has turned, since the late 1980s, to
consider the putative decline of medical dominance, the idea that
medicalisation is an inevitable or irreversible process, has become less
plausible. Indeed, it is conceivable, that if, as Conrad and Schneider (1992)
argued, medicalisation as a general societal trend is particularly associated
with modernity, and if we are now entering a post-modern era, then one
might expect to see an increase in demedicalisation (Elston et al., 2002).
In the body of this paper, we consider these developments in turn. First,
we describe how the broad concept of medicalisation was presented in the
early literature and outline different accounts of agency shaping the process,
beginning with medical dominance, and moving on to the idea of active
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patients and lay people. This leads us to consider more nuanced, multi-
dimensional accounts of specific conditions, which indicate that medicalisa-
tion might be a much more complex, ambiguous, and contested process than
the ‘medicalisation thesis’ of the 1970s implied. Finally, we return to consider
the macro-level societal context and likely trends in medicalisation.
THE CONCEPT OF MEDICALISATION
Medicalisation has been defined as a ‘process whereby more and more of
everyday life has come under medical dominion, influence and supervision
(Zola, 1983, p. 295). The idea that medicine might be enlarging its sphere of
influence to incorporate more and more aspects of the social world emerged
during the 1960s. Critics of psychiatry (eg Szasz, 1963) expressed concerns
over the increasing tendency for socially problematic behaviours such as
excess alcohol consumption and, at that time, homosexuality to be regarded
and treated as medical conditions. This growing reliance on medicine also
appeared to be occurring in other aspects of life such as childbirth,
menopause, and ageing, leading Zola (1972) and Freidson (1970), among
others, to claim that medicalisation should be understood as manifesting an
ongoing shift in social control processes in modern societies. Conrad (1975)
argued that medicine, as opposed to the church, the family or the state
(through its criminal justice systems) was becoming the dominant institution
of social control, as certain categories of deviant behaviour were being re-
defined as medical rather than moral problems.
According to Conrad and Schneider (1980a, b) and Lowenberg and Davis
(1994), medicalisation of deviance has three main implications: (1) according
deviants some degree of absolution from moral responsibility for their actions
or conditions (such absolution being conditional on willingness to accept
appropriate advice and treatment from medical professionals); (2) favouring
therapeutic rather than punitive interventions, with an optimistic view of the
effectiveness of the former; and (3) increased authority for the medical
profession in controlling deviance (Conrad and Schneider, 1980a).
Thus, in these early formulations, medicalisation was seen as a general
social trend which involved the extension of medicine’s jurisdiction over
erstwhile ‘normal’ life events and experiences, as these became categorized
as problems appropriate for medical supervision and intervention, and over
already recognized social problems and deviance, which were being
reclassified from ‘badness’ to ‘sickness’ (Conrad and Schneider, 1980a, b,
1992). It is probably fair to say that, within medical sociology, with the
exception of studies of mental health issues, it has been the medicalisation of
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‘normal life’ that has been the predominant concern. Accordingly, we
concentrate on this here.
Medicalisation and medical dominance
Reflecting the concept’s origins in criticisms of the expansion in psychiatric
jurisdiction in the 1960s, in the medical sociology literature of the 1970s and
early 1980s, medicalisation was usually linked to the medical profession’s
dominant position in society. Indeed, what became tagged as the ‘medicalisa-
tion thesis’ generally attributed the process to the specific professional
aggrandising activities of medicine (Blaxter, 2004). For example, in the
context of his extended discussion of the development of an autonomous
medical profession, Freidson (1970) suggested that the medical profession
used the power gained through their specific knowledge and expertise to
control what constitutes health and illness. As Freidson stated, ‘Once official
jurisdiction is gained, the profession is then prone to create its own
specialized notions of what it is that shall be called illness’ (1970, 251).
Through specifying what should be identified and treated as illness, Freidson
argued that doctors, at least in the United States in the mid-20th century, were
acting as moral entrepreneurs as they extended medical monopoly over the
management of more aspects of life.
Sharply critical versions of this depiction of the medical takeover of
everyday life was found in the contemporary anti-medical polemics that
characterized the radical health politics of the 1970s in both Europe and the
USA. For example, although he did not generally use the term ‘medicalisa-
tion’, Illich (1976), a notable critic of industrial societies of the period,
attacked the medical profession as being responsible for what he saw as
increased societal dependence on medicine. He suggested that the medical
profession had not only convinced (on dubious evidence according to Illich)
the lay population that doctors had a valuable body of knowledge and skills,
but also that the profession had damaged lay persons’ capacity to manage
matters of health and illness themselves, and, hence, their autonomy. Thus,
the medical profession were, according to Illich (1976), securing a large and
growing market for their services in perpetuity, while bringing about
iatrogenesis. Under the guise of providing a cure, medicine was, according
to Illich, actually producing harm at the clinical level (through ineffective
treatment and side effects etc), at the social level (people were becoming
more dependent on pharmaceuticals), and at a structural level, as society’s
capacity to cope with illness and death in a meaningful way was reduced. For
Illich, therefore, medicalisation was a regrettable development, for which the
bureaucratized medical profession was largely responsible.
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Another critical perspective, in the 1970s, on the putative medical
takeover of normal body processes and life events was found in 1970s’
feminists’ analysis of the changing management of women’s reproductive
experiences, for example childbirth. From a situation in which, prior to the
20th century, most expectant women did not receive medical attention at any
point in the pregnancy, medical advice and intervention related to
reproduction are now sought as a matter of course, not only from early in
pregnancy, but even before conception. Many second-wave feminists of the
1970s and 1980s attributed this medicalisation of childbirth to medical
dominance, regarding medicine as a particularly powerful patriarchal agency
exercising undue social control over women’s lives (Oakley, 1984; Bell,
1987). As Oakley states, by developing a conceptual difference between
‘abnormal’ and ‘normal’ pregnancy, the medical profession ‘constructed a
schema of pregnancy which systematized what was taken to be the everyday
experience of pregnant women’ (Oakley, 1984, p. 14). By defining the
parameters of ‘abnormality’, and establishing the routine use of medical
monitoring and intervention during pregnancy and childbirth, obstetricians
have, according to Oakley (1980), placed undue emphasis on the probability
of abnormality, and thus, on the need for all women to be dependent on
medical care.
Similarly, the availability of, and increased reliance on, the measurement
of blood hormone levels to diagnose the menopause and to indicate a ‘need’
for treatment with hormone replacement therapy has been taken as evidence
of medicalisation of this stage of women’s lives. McCrea (1983) argued that,
as a result of medical definitions of the menopause as a ‘deficiency disease’,
many women came to feel morally obliged to accept medical intervention in
order to prevent future ill-health.
A slightly different account of the links between medicalisation and
medical dominance was put forward by Marxists such as Navarro (1975) and
Waitzkin (1979, 1984) in the 1970s and early 1980s. Their argument was,
essentially, that capitalism stood to gain from society’s increasing depen-
dency on medicine in two main ways; (1) extending the individualistic
medical model and according high status to the medical profession,
encouraged the adoption of personalized solutions, such as anti-depressant
drugs, for socially caused problems; (2) increasing consumption of medical
consumer goods created increased profits. Those who have the means to
produce and market these goods (eg the medical profession and the
pharmaceutical industry) are not only able to make economic gains from
increased consumption, but this economic gain then serves to sustain their
dominant position within society. Thus the interests of doctors and of
capitalism generally were alleged to be served by medicalisation.
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The literature described so far regarded institutionalized medical
dominance, whatever its basis, as the key factor in the general trend of
medicalisation. The medical profession’s monopolistic control of specialized
medical knowledge and skills; its nurturing of dependency on medicine
amongst the lay population; and its expanding ability to define areas of
abnormality as amenable to medical intervention, were alleged to be bringing
about this major shift in social control. Such views generally implied, tacitly
or explicitly, that medicalisation was not in patients’ interests, a position
informed by the contemporaneous questioning of the effectiveness of
interventionist medicine then emerging; for example, that associated with
McKeown (1976). However, even in the 1970s, there were medical
sociologists, (most notably (Fox, 1977; Strong, 1979), who suggested that
some accounts of ‘medical imperialism’, were exaggerated. More recently,
this questioning has increased and some of the original proponents of the
medicalisation thesis have qualified and clarified their positions (Conrad,
1992; Conrad and Schneider, 1992).
As a result, there is now a significant body of literature that suggests that
medical dominance and medicalisation are not synonymous and that lay
persons are not necessarily passively dependent in the process of
medicalisation or disadvantaged by it. It is to this literature on the active
lay participant’s role in medicalisation of specific body processes and
‘problems’ that we now turn, beginning with analyses of women’s concerns
over reproductive issues.
Medicalisation and the active participant
Although there was a tendency, in much of the second-wave feminist
literature, to present women as passive victims of medicalisation, Kohler
Riessman (1983) argued that this approach merely perpetuated the very sexist
medical ideologies that feminists have been trying to challenge. She suggested
that women stand to gain as well as lose from medicalisation of, for example,
childbirth, and that women have actively contributed to the redefining of
women’s experiences into medical categories in order to improve their own or
their families’ wellbeing. Using childbirth as an example, Kohler Riessman
(1983) eloquently presents historical evidence to support her claim that
women not only contributed to its medicalisation, but also that their
participation was driven by a complex set of reasons. The reasons included,
for example, the need for working class women to be relieved from lingering
incapacity following childbirth, and, for more middle class women, the desire
to be free from pain and to choose the kind of delivery they would have.
More recently, women have been shown to resist medicalisation of the
menopause, being active participants in decisions about the use of hormone
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replacement therapy (HRT). Although the increased use of HRT over the
latter part of the 20th century arguably constitutes at least partial
medicalisation of the menopause, Griffiths (1999) found that women were
not simply passive recipients of medical intervention. Rather, they were
active in seeking and evaluating information about HRT, and also questioned
the doctors’ advice.
As Lewis (1993) argues, the medicalisation of natural life processes such
as childbirth and the menopause is not necessarily a matter of medical
conspiracy, but a process in which many women have made demands for the
‘best’ care, while also sometimes resisting medicalisation. Similarly, Denny
(1994) and Rajan (1996) have used empirical evidence to show how medical
technology can serve as a resource for women, and as a means of liberation
from the constraints of their embodiment.
Those who regard the lay populace as active participants, therefore,
might view medicalisation as representing the positive utilization of
medicine to improve the way in which problematic social experiences and
forms of deviance have previously been managed. Thus Broom and
Woodward (1996) found that doctors’ diagnosis of distressing symptoms
as ‘chronic fatigue syndrome’ was found helpful by sufferers. In some
contexts, lay persons have actively campaigned for a medical label,
particularly for symptoms related to lifestyle, such as stress or fatigue.
Most notably, in the case of contested diagnoses such as Chronic
Fatigue Syndrome and Repetitive Strain Injury (Arksey, 1994; Broom and
Woodward, 1996), patient self-help groups have been among the most
vociferous in demanding medicalisation, in the form of recognition of their
conditions as being caused by objective, even if not yet confirmed,
pathological processes.
Thus, rather than patients being passively duped into accepting
doctors’ orders, it has been found that there may be patient pressure on
doctors, or at least be collaboration (Broom and Woodward, 1996) or
collusion between the two. For example, De Swaan (1990) suggests that
medicalisation may arise through negotiation, with the lay population
wishing to seek help, and the medical profession wishing to provide that
help. Such analyses clearly suggest that the medicalisation of an area of
life may not be uncontested, and might not necessarily be medically
induced. It may be actively embraced or resisted by various parties.
Thus, medical sociologists have increasingly turned to examination of the
particular contexts and protagonist characteristics that are conducive
(or not) to medicalisation, and of the different forms that medicalisation
might take, rather than assuming it to be the inexorable outcome of medical
dominance.
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UNPICKING THE PROCESS OF MEDICALISATION – AND ITS CONVERSE?
That medicalisation might not follow a unilinear and simple course was, in
fact, clearly flagged in some of the early sociological literature, although not
always taken up at the time. For example, in response to their early critics,
Conrad and Schneider (1980b) suggested that there are three levels to
medicalisation; (1) the conceptual level, where medical language is used to
define the problem; (2) the institutional level, where medical collaboration
with other authorities is used to gain legitimacy over management of the
problem; and (3) the level of interaction between the doctor and the patient,
where the problem is defined as ‘medical’ and medical treatment is
administered (Conrad and Schneider, 1980b). Later, Lowenberg and Davis
(1994, p. 582) have suggested that the three corollaries of medicalisation cited
above (extending the medical model to new areas; absolution of sufferers
from moral responsibility and management by qualified professionals) should
be regarded as potentially separable phenomena.
Analytical separation of different levels and dimensions of medicalisation
has provided a framework within which it becomes possible to recognise that
there might be different degrees of medicalisation; that the different
dimensions of medicalisation might not always co-exist in close parallel;
and that demedicalisation along one or more dimension might also occur.
Indeed, one much cited example of demedicalisation occurred in the early
1970s, when homosexuality was officially declassified as an illness by the
American Psychiatric Association, following lobbying by the gay liberation
movement (Conrad, 1992). Thus, homosexuality has come to be seen in
many affluent countries as neither disease nor deviance, but as a lifestyle
choice. Another putative example of demedicalisation is the social model of
disability promulgated by the disability movement in recent years. Here, there
is a clear attempt on the part of a collectively organised group to delegitimise
the application of a medicalised conceptual framework to the ‘problems’
faced by the disabled (Zola, 1993; Oliver, 1996). A further example of partial
demedicalisation at the conceptual level by psychiatrists in the UK was the
adoption, from the 1970s, of the classification ‘personality disorder’ for some
forms of psychopathy deemed untreatable by medicine, effectively (re)crimi-
nalizing such behaviour (Ramon, 1986). In the realm of physical medicine, a
recent paper has suggested that acute respiratory infections, such as sore
throats are in the process becoming demedicalised at the level of interaction
between the doctor and the patient (Ashworth et al., 2005). For, while Little
et al. (1997) suggested that doctors were instrumental in medicalising self-
limiting sore throats through the overuse use of antibiotics, Ashworth et al.
(2005) have recently found significant reductions in antibiotic prescription for
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respiratory infections, which appears to have led to a decline in medical
consultation for these conditions.
These examples suggest that the extent and form of medicalisation of
specific kinds of deviance or life experience, and the degree to which any
process of medicalisation is sustained over time, varies according to the social
or cultural authority and the level of mobilisation of those making (or
resisting) claims, and the perceived efficacy of any medical intervention.
Moreover, it is also possible that, by the end of the 20th century, there was
new potential for demedicalisation arising from wider social changes, and
from the very process of medicalisation that appeared to be so pervasive three
decades earlier. In the next section, we consider this possibility.
THE SOCIETAL CONTEXT AND THE CHANGING POTENTIAL FOR
MEDICALISATION
As illustrated above, much of the medicalisation literature has focused on the
roles that the medical profession and, latterly, the lay population have played
in bringing about the medicalisation of specific aspects of everyday life.
Sometimes, this has been with relatively little reference to the broader social
context in which medicalisation was allegedly taking place. Yet in their early
discussions, both Zola (1972) and Conrad (1981) explicitly suggested that
there were wider social processes shaping medicalisation as a general trend.
Thus, Conrad and Schneider linked medicalisation to the rise of rationalism,
and the success of the medical model since the 19th century (1992, p. 261).
According to Zola (1972), ‘the medicalising of society is as much a result of
medicine’s potential as it is of society’s wish for medicine to use that
potential’ (Zola, 1972, p. 182). The point is that, in Judaeo-Christian societies
in which illness is understood as a state that individuals and society should
take active steps to prevent and treat (Parsons, 1951; Shilling, 2002), if
medicine comes to be seen as the appropriate and effective authority on
prevention and treatment, then the continuing expansion of medicine’s
jurisdiction becomes likely. An iterative, self-reinforcing process (whether
driven by doctors or patients) is apparently set in train, of growing potential
for and realization of medicalisation because of societal faith in the
effectiveness of medicine and so on.
Indeed, Crawford (1980) described contemporary societies as being
characterized by ‘healthism’, that is, by a pre-occupation with the ‘problem’
of health and with disease prevention, in which a ‘medicalised perception
sets boundaries on ways of thinking and channels consciousness and
behaviour’ (1980, p. 371). For example, where once physical activity might
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have been undertaken for the purpose of pleasure, it may now be understood
as a medically relevant activity, undertaken for the purposes of good health
(De Swaan, 1990, p. 59). According to Crawford, healthism is morally laden
(1980, p. 371). This idea of morally regulating behaviour resonates, not only
with Parsons’s view of the moral obligations of patients to try to get well, but
also with the Foucauldian view that, through medical surveillance,
individuals in contemporary society come to see conformity to medically
defined normality as ‘good’ behaviour (Turner, 1987; Armstrong, 1995).
Although not strictly identified as ‘medicalisation’, this Foucauldian notion of
normalization suggests that the ‘clinical gaze’ can, in theory, expand into any
aspect of social life that can be visualized (Armstrong, 1995). As techniques
with which to observe, examine, measure and make comparisons against an
established norm expand, new dimensions of the medical body become
visible. This, in turn, creates new ways of conforming to normality for
individuals (Lupton, 1997).
Thus, for Zola and Conrad, medicalisation was the product as well the
cause of societal faith in medical knowledge and practice. However, since
they first wrote about medicalisation, there has been increasing questioning
of some of the claims of the modern medical profession about the efficacy,
effectiveness and safety of their interventions to treat and prevent illness.
Indeed, their own work was part of the early questioning and stimulated
more. At the same time, the increased opportunities for medical diagnosis and
intervention described above have arisen alongside a growing awareness of
and concern for risk (Beck, 1992). On the one hand, the coalescence of
heightened risk perception and availability of new technologies provides
further potential for medicalisation. Conditions such as the menopause come
to be medicalised through the use of HRT and latterly, non-oestrogenic
preparations, as (1) it becomes possible to measure bone density and identify
‘abnormalities’; (2) the therapy becomes more accessible and (3) as
individuals (both women and medical profession) become more concerned
about the risk of osteoporosis. On the other hand, however, concerns over
risks may also serve to limit the potential or even reverse some aspects of
medicalisation, or at least of the ways in which it is enacted. For example,
emerging evidence of risks associated with pharmaceutical products may lead
to reduction in their use, as appears to be the case currently with HRT
(Lawton et al., 2003). Williams and Calnan (1996) argue that, in a world
characterized by social reflexivity and uncertainty, people are becoming both
more sceptical about and more dependent on medical and technological
developments, and are both active and passive within the medical encounter.
Indeed, the increased controversy and uncertainty surrounding hormone
replacement therapy, has been shown to affect women’s active participation
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in decisions about the therapy, as they have turned to the medical profession
for help and advice (Griffiths, 1999).
Moreover, new medical technologies, along with an ageing population,
have contributed to concern about increasing healthcare costs in affluent
societies, and greater scrutiny of the ‘value for money’ of medical
interventions. This ‘crisis’ in welfare expenditure has, in turn, led both
public and private funders of health care to promote self-care in preference to
allegedly ‘inappropriate’ direct reliance on professional medical intervention.
For example, the NHS in England has launched a national telephone and
internet advice service ‘so that [people] are better able to care for themselves
and their families’ (Department of Health, 1997). Or, to take a specific
treatment example, while statin drugs have been developed to prevent
cardiovascular disease, their widespread use would present a major financial
challenge for publicly funded health care in the UK precisely because so many
people are at risk of cardiovascular disease. This conundrum was resolved in
2004 by making available low-dose formulations for direct purchase without
a doctor’s prescription (Freemantle and Hill, 2002).
Self-care could be described as demedicalisation at the interactional level,
although the conceptual and ideological framework within which it is
promoted remains a medical one. With the new emphasis on self-care comes
an emphasis on the moral obligation of individuals to take active steps to
prevent and treat ill-health, seeking the advice of competent experts directly
when appropriate but also looking after themselves. In this process, as
Lowenberg and Davis (1994) argued in relation to the growth of holistic
medicine, the absolution of sufferers from moral responsibility for their
condition (one corollary of the original medicalisation thesis) is being
qualified. Lay people, it appears, are becoming at least partially re-
responsibilized in relation to their health, to take care of it themselves as
well as seeking help from experts. At the same time, criminologists have
drawn attention to recent developments in penal policy in which an emphasis
on therapeutic and rehabilitative measures for ‘victims’ of society is being at
least partially displaced by a more punitive approach to managing those who
are ‘responsible for their own misfortunes (Rose, 1996; Garland and Sparks,
2000). In this sense, some forms of deviance may be becoming partly
demedicalised by recategorization as ‘badness’, to be managed by non-
medical social control agencies (Elston et al., 2002).
Thus, at the turn of the 21st century, far from there being an inexorable
trend towards medicalisation, there seems to be oscillation between
medicalisation and demedicalisation of many aspects of everyday life. It
would seem that the increasing potential for medicalisation is juxtaposed
with concerns about risk and the financial pressures that partly arise from the
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very process of medicalisation. Some self-help and ‘user’ groups press for
increased medical recognition of the legitimacy of their claims to be ill. At the
same time, new social movements have challenged the applicability of
medical categories to what the movements claim to be non-pathological
behaviours or body processes.
Increased concern with risk, the responsibilization of individuals, the
challenging of experts’ authority and scientific knowledge, the rise of new
social movements: all these are themes of the contemporary literature on
social change which argues that modernity is being superceded as a social
order, being replaced by what is variously termed the risk society, advanced
liberalism, post- or late-modernity (Scambler and Higgs, 1998).
CONCLUSIONS
Three tentative conclusions might be drawn about medicalisation as a
concept in medical sociology. First, when read with the benefits of hindsight,
some accounts of medicalisation in the 1960s and 1970s probably were
overdrawn, over-emphasizing the medical profession’s imperialistic tenden-
cies and perhaps underplaying the benefits of medicine (Strong, 1979).
Secondly, conceptualising medicalisation as a uni-dimensional, uniform
process or as the result of medical dominance alone is clearly insufficient: in
any given context, there may be claims and counter-claims and competing
interests, and the outcome of moves to expand medical jurisdiction is not
inevitable. Thirdly, claims of a general increase in medicalisation reflecting
changes in modes of social control of deviance may have been appropriate for
the middle years of the 20th century. However, this does not mean that this
trend continues inevitably and inexorably. 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
should not be surprised if there is more contestation of medicalisation.
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KEY PAPERS
Conrad P, Schneider JW (1980b). Looking at levels of medicalisation: a comment on Strong’s
critique of the thesis of medical imperialism. Social Science and Medicine 14A: 75–79.
Conrad P, Schneider JW (1992). Deviance and Medicalisation: from Badness to Sickness, 2nd edn.
Temple University Press: Philadelphia.
Kohler Riessman C (1983). Women and medicalisation: a new perspective. Social Policy 14:
3–18.
Lowenberg JS, Davis F (1994). Beyond medicalisation-demedicalisation: the case of holistic
medicine. Sociology of Health and Illness 16: 579–599.
Strong P (1979). Sociological imperialism and the profession of medicine: a critical analysis of the
thesis of medical imperialism. Social Science and Medicine 13A: 199–215.
Zola IK (1972). Medicine as an institution of social control. Sociological Review 20: 487–504.
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... If we turn to the second issue, medicalisation (explained below), data in this chapter support recent challenges to the concept of medicalisation as unidimensional (Ballard and Elston, 2005). To explicate, medicalisation -the notion that everyday social practices have increasingly come under the jurisdiction of biomedicine -was initially theorised in relation to medical dominance and the social and cultural authority of biomedicine (see Zola, 1972). ...
... However, this uni-dimentional view of medicalisation has been challenged (see Ballard and Elston, 2005). An alternative perspective is that 'patients' are not passive victims of biomedical power, but rather can actually benefit from medicalisation (Kohler Riessman, 1983), may actively resist medicalisation (Ballard and Elston, 2005) or simultaneously resist medicalisation while demanding quality care. ...
... However, this uni-dimentional view of medicalisation has been challenged (see Ballard and Elston, 2005). An alternative perspective is that 'patients' are not passive victims of biomedical power, but rather can actually benefit from medicalisation (Kohler Riessman, 1983), may actively resist medicalisation (Ballard and Elston, 2005) or simultaneously resist medicalisation while demanding quality care. Moreover, some studies have found non-medical people to be vehement in their quest to get a medical categorisation of their condition, as has been found in the case of those with Chronic Fatigue Syndrome and Repetitive Strain Injury (Arksey, 1994: Broom andWoodward, 1996). ...
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Study of the menopause in Ireland funded by the Women's Health Council
... Other authors attribute meaning to the contestation of medicalization, assuming it as the expression of dynamics strongly articulated to a societal context marked by a more significant critical questioning that takes shape in scrutiny fed by increasing levels of social reflexivity and a keener awareness of the risks and limitations of expert approaches [198]. ...
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... While it is true that there is still little empirical work on the biopolitical and medicalizing effects of premodern and holistic medical systems (Lowenberg and Davis 1994), a longer and more plural history of biopolitics may be more productive on a number of counts. It can avoid the stagelike simplifications of thinking in terms of teleological succession from sovereign power to discipline to biopolitics (as Foucault himself cautioned 2007); by decoupling biopolitics and normalization from modern medicine it can open up a field of enquiry not just about past (and present) intense biopolitical effects of holistic medical systems and practices but also about contemporary forms of hybridization of Western biomedicine and alternative or traditional non-Western medicine (see for Ayurveda: Subramaniam 2019; Rooney 2020; Meloni 2021); it may lend further complexity to a multilayered history of medicalization (Ballard and Elston 2005;Busfield 2017), suggesting that the modern rise of experts did not colonize otherwise pristine bodies. It can, finally, suggest humility in some of the epochal claims we have seen in the discipline in the last few decades: notions that the pursuit or 'imperative of health' is an unprecedented feature and value of late modernity (Lupton 1995); that the human body was "fabricated" at the end of the eighteenth century (Armstrong 1985), as if other cultures did not also display different forms of fabrication and control of bodies and populations; that advanced capitalist societies are the first 'somatic society' that have established a direct relationship between bodies and selfhood (Rose 2001, see on the intense somaticism of premodern humoralism my 2019). ...
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Foucault's argument that a major break occurred in the nature of power in the Euro-pean Eighteenth century-an unprecedented socialization of medicine and concern for the health of bodies and populations, the birth of biopolitics-has become since the 1990s a dominant narrative among sociologists but is rarely if ever scrutinized in its premises. This article problematizes Foucault's periodization about the politics of health and the way its story has been solidified into an uncritical account. Building on novel historiographic work, it challenges the modernist bias of histories of biopolitics and public health and considers an earlier and more plural history of collective practices of health of which the story told by Foucault is just one important episode. Finally, it discusses the implications of this revised model for wider sociological debates on the link between modernity, health and the body.
... 195-197;Zola, 1973). They claimed that medicalization was a feature of modernity and simply aimed at increasing the role of doctors within Western societies (Ballard, Elston, 2005). Although some scholars still associate medicalization with the economic expansion of the pharmaceutical industry (Clarke, Shim, Mamo et al., 2003, pp. ...
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