How Medicalization in Western Society Is Becoming a Universal Truth

How medicalization in western society is becoming a universal truth. – focus on what is it in society that causes whatever it is that you are exploring.

This essay will critically discuss how, in contemporary society, a person’s state of being can become classed as a medical illness through the process of medicalization in western society and then how that becomes accepted as a universal truth that is then transported to other parts of the world through globalisation. This essay will first discuss what medicalization is sociologically speaking with reference to the foundational work of Peter Conrad and two ways that he believes society encourages medicalization. Then, how medicalised western notions of mental health conditions are becoming a universal truth around the world due to globalization and the effect that that has on the society taking on those western ideas will be examined. This will relate to three examples which are outlined in Ethan Watters (2010) book surrounding how western notions of mental illness spread.  Firstly, western notions of post-traumatic stress disorder being brought over to Shi Lankan culture will be discussed, followed by depression to Japan and anorexia to Hong Kong. This relate to sociology as the examples will focus on what in that society caused and allowed for globalisation of the western ideas of mental illness to occur and impact their society and what in western society caused our ideas to become globalised. Prior to the examples however, the work of Edward Shorter and Laurence Kirmayer will be touched as their work may provide explanation for how and why different cultures differ in how they experience and understand what in western society we may believe to be mental illness.

Medicalization is the name given to the process by which behaviours, conditions, orientations etc that were previously thought to be non-medical, though they may be seen as deviant or abnormal in some cases, become redefined as a medical condition thus allowing the medical field to intervene with diagnosis, prevention and treatment (Conrad 2007).  This phenomenon ties into the sociological concept known as social construction. When something is socially constructed, there is a shared and accepted idea of how something should be within society created by the people in that society. This ties into medicalization as society and the medical field has socially constructed illnesses out of behaviours/conditions that were previously not a medical issue. Society has accepted the ideas that certain behaviours/conditions are medical conditions so therefore there is a socially constructed nature of medical conditions and illness (Conrad and Barker 2010). This does not mean however that symptoms and conditions are not real, it simply means that the medical label/diagnosis given to a set of symptoms or behaviours is created by people in society and is therefore socially constructed. Conrad and Schneider (1980a) suggest a five-stage model for the medicalization of deviant behaviour…

According to Conrad’s (1992) there are particular social factors that encourage medicalization to occur. One example Conrad (1992) suggests that encouraged mediatization was the changing organization and structure of the medical profession.  The medical profession has power and jurisdiction over all things health and illness related. Over time, the medical profession has encouraged medicalization, the more behaviours and conditions that are considered medical, the more power the profession has with the increasing number of areas they have jurisdiction over. This suggests that the medical field monopolizes, gains power and profits over previously non-medical related behaviours becoming labelled as medical conditions. Pawluch (1983) and Halpern (1990) both hypothesise differing ways that medicalization is a by-product of the medical profession. Firstly Pawluch’s (1983) market hypothesis suggests that the medical profession can adapt with time to maintain their power, and in order to adapt, they medicalise behaviours previously thought of as non-medical so that they are still needed and relevant to society to help these new medicalised conditions. An example used is paediatricians who specialise in children’s health. Previously they were needed to treat illness that have now been reduced and prevented by vaccination. In order to maintain relevant with the decrease in sick children, children’s problem behaviours became medicalised so that paediatricians had something to treat such as hyperactive behaviour became Attention deficit hyperactivity disorder (ADHD) (Conrad 2007). This allowed paediatricians to maintain and enhance their medical dominance by expanding their territory. Halpern’s (1990) routinization hypothesis however suggests that medicalization does not occur in order to maintain relevancy but due to the fact that because there is increased routine in patient care which was seen as tedious and uninteresting, new medical conditions have been created so that doctors can become specialised in new illnesses and then continue to work in academics teaching that specialist subject to medical students. Working in academics is seen as more stimulating, so medicalization occurs so that the many physicians in the medical field can become managers of medical care while others can perform the routine work. Another example that Conrad (1992) suggests is that secularization, the decrease in importance that religion plays within society, may increase mediatization as religion is replaced by medicine and science. This largely occurred during the enlightenment period in the 18^th century where rationalism was introduced, the medical model started and the growth of modern science began (McKay 2014). Conrad (1992) also used the example anorexia nervosa as a medical condition and said that the condition was seen to be used by individuals to reach their own new non-religious idea of perfection relating to their body image whereas previously with religion being a more influential and important part of society, perfection would have been gained by achieving inner spiritual peace by giving yourself to your religion. Anorexia here is an example of a starving behaviour that has been classified as a medical condition through medicalization which has occurred due to societal factors, in this case the lack of a religious presence. Both aspects mentioned that encourage medicalization in society and the overall increase in scientific culture appear to correlate with western society which could suggest why western societies have many examples of medicalization including the three examples in the following paragraphs. An example showing a decrease in religious influence in Western society can be taken from the Office of National Statistics (2011/13) which states that in England and Wales, the predominant religion Christianity, dropped from 72% to 59% of the population reporting to be Christian from 2001 to 2011, which is 4.1 million fewer people. Also, 6.4 million more people were reporting to be non-religious in the same time frame, increasing from 15% of the population to 25%. Although unfortunately these statistics do not cover all of western society, these two countries are integral parts of western society. Suris, Holliday and North (2016) studied the American Diagnostic and Statistical Manual (DSM) throughout time, manual surrounding mental disorders used by health professionals to diagnose psychiatric illnesses in this case used in America (part of western society), and found that there was an increase both in the amount of material and most importantly the number of clinical diagnoses from 106 diagnoses in the first edition published in 1952 to 265 in the third published in 1980. This provides evidence for medicalization occurring, showing the increasing number of behaviours/conditions being redefined as medical conditions.

In order to move on to how the western medicalized ideas of mental illnesses become globalised and impact other countries/cultures, we first must understand how and why cultures have differences in response and beliefs about mental illness in the first place by looking at the relationship between how society affects the unconscious mind. Edward Shorter and Laurence Kirmayer’s work can help to explain this. Shorter (1994, 2008) coined the term symptom pool which is essentially a limited number of symptoms/behaviours (ways of presenting illness) in a society that are considered as a signal for suffering, which is collective belief within each society but different between societies. He believed that when an individual faces an internal feeling that is difficult to express, they latch onto a symptom from this symptom pool as a means of expression. There is a difference between cultures in terms of what is expressed/ what symptoms are chosen because different symptoms in different cultures that are recognised as signals of suffering.  Shorter (1987) gave the example that Anorexia Nervosa in America, the medicalised term for starvation behaviour, is thought to be unconsciously chosen by an individual experiencing psychic distress in American/western society, to express what they are feeling as starvation in western society is a recognised signal for suffering. Shorter explains that people adopt certain behaviours over others as a means of expression because the culture in which that individual lives signals to them he appropriateness of the behaviour/symptom in the society. Society sends signals to individuals by medical professionals having a particular interest an illness such as anorexia increasing its legitimacy, the medical field providing individuals with information about which symptoms are considered serious and the acknowledgement that certain behaviours which behaviours show symptoms of legitimate illnesses such as starvation being a legitimate behaviour for Anorexia. Because anorexia has become a legitimate illness in western society shown by the medicalization of the illness providing legitimisation and the medical fields interest in the topic also providing legitimisation, this could explain why cases of anorexia have increased overtime. Individuals are increasingly likely to unconsciously choose symptoms of Anorexia such as starvation behaviours to express their internal feelings as they know that society will consider them has having legitimate suffering as they are performing symptoms of a legitimate mental illness. This also shows how culture is shaping the unconscious mind to create behaviours that correspond to medical diagnosis in society so that they can express themselves. Kirmayer’s (1989) cycle of symptom amplification ties into Shorter’s (1994) symptom pool as the cycle of symptom amplification. Cultures have differing ways of explaining various mental states such as depression (Kirmayer 2002). Cultures have differing ways of explanation due to them having differing beliefs about how the mind and the body function together and these beliefs direct individuals in that society towards/away from certain feelings/experiences of mental illness. This is the cycle of symptom amplification, the unconscious way in which an individual latches onto a symptom in the symptom pool that the society directs them towards.

It is important to look at how society shapes the unconscious mind because of globalisation, especially because western society has such a large impact on how the rest of the world think about mental illness and how they categorise it, which over time homogenises notions and experiences of mental illness.

What is globalization, ADHD http://drjkoch.org/ETOH/Fall%202015/ADHD%20Conrad%202014.pdf

What in western society allowed for globalisation to occur;

Anorexia Hong Kong media asked western opinion on western diseases, anorexia more popular in western society

Depression Japan – kirmayer 2002 pharmaceutical company, pharmaceuticalization

PTSD Sri Lanka we tried to help

Word count: 1715

Word limit: 3,300

References:

• Conrad, P., 1992. Medicalization and social control. Annual review of Sociology, 18(1), pp.209-232.
• Conrad, P., 2007. The medicalization of society: On the transformation of human conditions into treatable disorders. JHU Press.
• Conrad, P. and Barker, K.K., 2010. The social construction of illness: Key insights and policy implications. Journal of health and social behavior, 51(1_suppl), pp.S67-S79.
• (Conrad, P., Schneider,J. 1980a. Deviance and Medicalization: From Badness to Sickness. St. Louis: Mosby. 311 pp. https://halasocialdeviance.files.wordpress.com/2011/09/peter_conrad_joseph_w-_schneider_deviance_and_medicalization_from_badness_to_sickness__with_a_new_afterword_by_the_authors_-_2nd_expanded_edition__1992.pdf )
• Halpern, S.A., 1990. Medicalization as professional process: Postwar trends in pediatrics. Journal of Health and Social Behavior, pp.28-42.
• Kirmayer, L.J., 1989. Cultural variations in the response to psychiatric disorders and emotional distress. Social Science & Medicine, 29(3), pp.327-339.
• Kirmayer, L.J., 2002. Psychopharmacology in a globalizing world: The use of antidepressants in Japan. Transcultural psychiatry, 39(3), pp.295-322.
• MCKAY, J.P., 2014. A history of western society since 1300. 11^th ed.Boston, MA: Bedford/St. Martin’s.
• Pawluch, D., 1983. Transitions in pediatrics: A segmental analysis. Social problems, 30(4), pp.449-465.
• Shorter, E., 1987. The first great increase in anorexia nervosa. Journal of Social History, 21(1), pp.69-96.
• Shorter, E., 1994. From the Mind into the Body. The Cultural Origins of Psychosomatic Symptoms. New York (The Free Press) 1994.
• Shorter, E., 2008. From paralysis to fatigue: a history of psychosomatic illness in the modern era. Simon and Schuster.
• Surís, A., Holliday, R. and North, C.S., 2016. The evolution of the classification of psychiatric disorders. Behavioral Sciences, 6(1), p.5.
• Watters, E., 2010. Crazy like us: The globalization of the American psyche. Simon and Schuster.
• https://www.ons.gov.uk/peoplepopulationandcommunity/culturalidentity/religion/articles/fullstorywhatdoesthecensustellusaboutreligionin2011/2013-05-16#introduction

On hold:

Then pharmaceuticalization will be touched upon which is the role that the pharmaceutical industry plays in medicalization, it is a prominent manifestation of medicalization and the expanding jurisdiction of medicine.