Medicalization is central to the idea that medicine is an institution of social control, implying that all knowledge, including scientific and medical knowledge, is a social product, developed through processes of interpretation and negotiation that play a critical role in evaluating and legitimizing deviance. In this social constructionist perspective, illness and disease are forms of social deviance that need to be controlled or regulated through specially sanctioned agencies such as medicine. Medicalization is a concept that captures the processes through which medicine and medical culture categorize physical, emotional and social phenomena as normal or not-normal, and thus encroach on various aspects of social life. Political economists have argued that medicalization occurs primarily in capitalist societies that are characterized by processes of specialization and differentiation through which medicine expands its boundaries and colonizes new areas of the body and mind. Similarly, medicalization has proved a valuable analytic tool for feminists interested in exploring and explaining the relationship between medicine and the female body. Finally, while medicalization processes are not without conflict, medicalization is increasingly driven forward by the pharmaceutical industry.
Keywords: Deviance; Diagnosis; Functionalism; Medicalization; Political Economy of Health; Sick Role; Social Constructionism; Social Control
Medicalization is central to the idea that medicine is an institution of social control. Irving Zola (1972), whose work explores medical authority and power in capitalist societies, originally developed the concept. In Zola's framework, illness and disease are viewed as forms of social deviance that need to be controlled or regulated through specially sanctioned agencies such as medicine. Medicalization is a concept that captures the processes through which medicine and medical culture categorize physical, emotional, and social phenomena as normal or not-normal. In doing so, medicine encroaches on various aspects of social life and, to a degree, wins social consent from members of society for doing so (de Swaan, 1990). Diagnosis is important in the process of medicalization because it is through diagnosis that claims are made about what is considered normal and what is not.
Political economists have argued that medicalization occurs primarily in capitalist societies that are characterized by processes of specialization and differentiation, through which medicine expands its boundaries and colonizes new areas of the body and mind (Illich, 1976). Similarly, medicalization has proved an invaluable analytic tool for feminists interested in exploring and explaining the relationship between medicine and the female body. Central to the concept of medicalization is the idea that all knowledge, including scientific and medical knowledge, is a social product, developed through processes of interpretation and negotiation that play a critical role in evaluating and legitimizing deviance.
The Medicalization Thesis
The medicalization thesis emerged primarily in the 1970s as a way of explaining the expansion of modern medicine and its apparent ever-increasing reach into corners of social life. The concept of medicalization is derived from two main approaches to the study of health, illness and disease. First, medicalization is related to the political economy of health, in which good health (in capitalist societies) is viewed as a resource, as well as a state of being. As such, struggles between different social groups ensue over access to and control over whatever is required to produce and maintain good health (such as housing, food, medical care). Those who experience poor health, disabilities and/or advanced age, have less capacity to engage in this struggle for health (or to contribute to the production of commodities) and therefore come to be marginalized by society, or are viewed as deviant.
In the political economy perspective, certain social groups (e.g. minorities, women, people with disabilities, low income groups) have less access to resources that support good health and consequently experience poorer health. In this view medicine contributes to and reproduces social inequalities because its primary focus is on returning those who are sick (deviant) to the labor force, rather than addressing the conditions that create disease in the first place. Thus, medicalization plays a key role in labeling already marginalized social groups as socially deviant, and in securing social power, authority and status for doctors as members of a prestigious profession. Indeed, as more resources are devoted to disease and illness (deviance), medicine's status and power as a profession has grown, such that members of society tend to view medicine as a panacea for life's problems, rather than turning their attention to what is making them sick in the first place; that is, in the political economy perspective, social inequalities. While the political economy perspective was predominant in the 1970s, social constructionist perspectives largely displaced it in the 1980s and 1990s.
Social constructionism underpins the second element of the medicalization thesis. This perspective assumes that definitions of illness are the products of social processes and interactions between social groups. These interactions are characterized by inequality, in the sense that not all social groups have equal access to the capacity to produce knowledge or define what counts as knowledge about the human body and its vicissitudes (Nettleton, 1992). Medical practitioners have the power to define what counts as disease and illness as a consequence of negotiations with the state, which have resulted in their designation as professional groups, or experts (Witz, 1992). Such expertise can be considered a social resource, since all societies have social groups that are viewed as experts in relation to illness and disease (with the expertise to heal), from shamans to surgeons. However, the expertise that is conferred on medical practitioners by society also enables them to pass considerable judgment on which phenomena (be they behaviors or symptoms) come to be categorized as disease or illness, and how phenomena that are defined as medical should be handled. This power can have detrimental consequences, as we see especially in the case of childbirth.
The Example of Childbirth
Many researchers, especially those from feminist perspectives, have argued that childbirth and pregnancy have been socially constructed as a medical problem. In pre-modern societies it is generally noted that pregnancy was not viewed as a separate or special kind of experience. Researchers have argued that women expected pregnancy and childbirth to be accompanied by pain and discomfort (Donnisson, 1977) and there was very little formal advice given to women before or during pregnancy and childbirth. Instead, women tended to rely on each other for support through pregnancy and childbirth and they learned informally about what to expect through oral sharing of information.
Historically, childbirth attendance was mainly the preserve of women known as midwives who specialized in assisting friends and kin in giving birth. However, medical men who also practiced birthing wished to formalize the knowledge and practices of midwives as a way of developing a specialized, professional group (Witz, 1992). This process of formalization challenged the primacy of midwives in the early eighteenth century and subsequently, in the nineteenth century, as medicine became increasingly scientific, pregnancy and childbirth came to be seen as a pathological-and therefore clinical-event, in part because the men who attended births were largely associated with hospitals and hospital based medicine (Turner, 1987).
This specialized location enabled them to create a systematic knowledge base that supported the view that pregnancy needed to be managed via medical interventions and not allowed to simply happen as a natural event. The development of forceps (Wajcman, 1991) was critical in this process as it allowed doctors to deliver babies that would not otherwise have survived. However, it also allowed doctors to discredit midwives and marginalize them from the process of pregnancy and childbirth and in doing so, redefine pregnancy and childbirth from a natural event to a pathological event requiring medical surveillance and management. As Oakley (1980) argued in her classic study of the history of childbirth, the development of birthing technologies, from forceps to Cesarean sections, provided a way of restricting the informal practice of midwifery and cementing technical intervention as the hallmark of modern obstetrics.
In the twenty first century, pregnancy and childbirth continues to epitomize the significance of medicalization, as new technologies ensure that the pregnant woman and the baby she carries is supervised and monitored from early in conception through to delivery and even beyond (Apple, 1995). Nonetheless, there has been backlash against the medicalization of pregnancy and childbirth and growth in midwife deliveries as an alternative to medical supervision. For instance, in New Zealand, a majority of women register with a midwife rather than an obstetrician to manage their pregnancy (Jutel, 2006). Such a change allows the medicalization process as one of negotiation rather than as undisputed dominance and social control.
Central to the concept of medicalization is the idea that medicine is an institution of social control whose primary function is to deal with illness as a form of social deviance. This claim is based on the observation that areas of life that might be defined as natural or social have increasingly come under the scrutiny of medical culture and practice. For instance, natural human processes such as childbirth, aging and menstruation have all been defined as medical problems that require medical solutions. Zola (1972) argued that medicine has been central to handling social deviance in contemporary capitalist societies as the social power of religious institutions has diminished. In doing so, medicine develops experts upon whom people come increasingly to depend, in ways that diminish their own capacities to make judgments and deal with problems (Illich, 1976)....
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