Medicalized Doctors

First, once a situation becomes medicalized, doctors become the only experts considered appropriate for diagnosing the problem and defining appropriate responses to it. As a result, the power of doctors increases while the power of other social authorities (including judges, the police, religious leaders, legislators, and teachers) diminishes. For example, now that troublesome behavior by children is increasingly diagnosed as ADHD, parents, teachers, and the children themselves have lost credibility when they disagree with this diagnosis. Similarly, doctors are now given considerable authority to answer questions such as who should receive abortions or organ transplants, how society should respond to drug use, and whether severely disabled infants should receive experimental surgeries, while the authority of religious leaders and family members to answer these questions has diminished.

As this suggests, medicalization significantly expands the range of life experiences under medical control. For example, the natural process of aging is increasingly regarded as a medical condition. Doctors now scrutinize all aspects of the aging body and recommend psychological tests to measure mental decline, hormones to improve virility, cosmetic surgery for wrinkles, and more.

Second, once a condition is medicalized, medical treatment may seem the only logical response to it. For example, if woman battering is considered a medical condition, then doctors need to treat women and the men who batter them. However, if woman battering is considered a social problem stemming from male power and female subordination, then it makes more sense to arrest the men, assist the women financially and emotionally, and work for broader structural changes to improve all women’s status and options.

Third, when doctors define situations in medical terms, they reduce the chances that these situations will be understood in political terms. For example, China, Pakistan, and other countries have removed political dissidents from the public eye by committing them to mental hospitals. By so doing, these govern- ments discredited and silenced individuals who might otherwise have offered powerful dissenting voices. In other words, medicalization allowed these govern- ments to depoliticize the situation: to define it as a medical rather than political problem.

Fourth, and as the examples of China and Pakistan illustrate, medicalization can justify involuntary treatment. Yet treatment sometimes harms more than it helps. For example, since the 1980s, U.S. doctors have legally forced small numbers of women to submit to cesarean deliveries, in which babies are surgically removed from their mothers’ uteruses rather than delivered naturally through the vagina. In these cases, doctors argued successfully that childbirth is a dangerous medical condition rather than a natural process, that doctors are better qualified than pregnant women to judge fetuses’ needs, and that fetuses’ right to health is more important than women’s right to control their own bodies. Yet the rate of cesarean section in the United States is twice that recommended by the World Health Organization, suggesting that doctors are far too ready to perform this potentially life-threatening surgery. “Ethical Debate: Medical Social Control and Fetal Rights,” p. 108, explores how the growing ac- ceptance of the idea of “fetal rights” is affecting the lives of pregnant women.

Medicalization and the “Potentially Ill” In addition to creating new ill- nesses, medicalization has also led to labeling increasing numbers of individuals as “potentially ill”. The potentially ill are individuals identified as having an above-average risk of illness, whether because of age, stress level, tobacco use, family history, med- ical test results, or other factors.

The risks faced by the potentially ill vary substantially. Some learn that they carry a gene guaranteed to cause a fatal disease. Many more, however, learn that they have a condition such as high cholesterol that may increase their risk of illness. The numbers of such individuals continues to increase as corporations de- velop more tests for risk factors and as doctors (often reimbursed per test) adopt such tests. Similarly, the ranks of the potentially ill have expanded as pharmaceuti- cal companies have encouraged both doctors and consumers to expand their ideas about health risks and to adopt treatments for those risks. For example, pharma- ceutical companies have worked not only to broaden the definition of osteoporosis but also to create a new category, osteopenia, for those at risk of osteoporosis. Because osteoporosis refers to the risk of bone fractures caused by low bone density, osteopenia is essentially the risk of a risk of a health problem.

As this suggests, the health benefits of learning that one is potentially ill depend on the magnitude of the identified risk and the effectiveness of available treatments. Those benefits, however, must also be balanced against the psychological distress caused when people without any symptoms learn that illness might strike at any moment. In addition, some of these individuals experience the stigma of illness without any of the benefits that those who have illnesses may receive such as legal protection from discrimination.

The Rise of Demedicalization The problems inherent in medicalization have fostered a (much smaller) countermovement of demedicalization (Conrad, 2007). A quick look at medical textbooks from the late 1800s reveals many “dis- eases” that no longer exist. For example, 19th-century medical textbooks often included several pages on the health risks of masturbation. One popular textbook from the late 19th century asserted that masturbation caused “extreme emacia- tion, sallow or blotched skin, sunken eyes, . . . general weakness, dullness, weak back, stupidity, laziness, . . . wandering and ill-defined pains,” as well as infertility, impotence, consumption, epilepsy, heart disease, blindness, paralysis, and insanity (Kellogg, 1880:365). Today, however, medical textbooks describe masturbation as a healthy part of human sexuality.

Like medicalization, demedicalization often begins with lobbying by consumer groups. For example, medical ideology now defines childbirth as an inherently dangerous process, requiring intensive technological, medical assistance. Since the 1940s, however, some American women have attempted to redefine childbirth as a generally safe, simple, and natural process and have promoted alternatives ranging from natural childbirth classes to hospital birthing centers, to home births assisted only by midwives. Similarly, and as described in Chapter 7, activists have at least partially succeeded in redefining attraction to members of one’s own sex from a pathological condition to a normal human variation. More broadly, innumerable books, magazines, television shows, and popular organizations now exist that focus on teaching people to care for their own health rather than (or in addition to) relying on medical care.