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Medicine, Health Care and Philosophy
Published in: Medicine, Health Care and Philosophy 1/2019

Open Access 01-03-2019 | Scientific Contribution

How to distinguish medicalization from over-medicalization?

Author: Emilia Kaczmarek

Published in: Medicine, Health Care and Philosophy | Issue 1/2019

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Abstract

Is medicalization always harmful? When does medicine overstep its proper boundaries? The aim of this article is to outline the pragmatic criteria for distinguishing between medicalization and over-medicalization. The consequences of considering a phenomenon to be a medical problem may take radically different forms depending on whether the problem in question is correctly or incorrectly perceived as a medical issue. Neither indiscriminate acceptance of medicalization of subsequent areas of human existence, nor criticizing new medicalization cases just because they are medicalization can be justified. The article: (i) identifies various consequences of both well-founded medicalization and over-medicalization; (ii) demonstrates that the issue of defining appropriate limits of medicine cannot be solved by creating an optimum model of health; (iii) proposes four guiding questions to help distinguish medicalization from over-medicalization. The article should foster a normative analysis of the phenomenon of medicalization and contribute to the bioethical reflection on the boundaries of medicine.
Footnotes
1
Although there is no room in the article for in-depth ontological or epistemic considerations, it should be noted that whenever I use such words as “reality”, “causes”, “objective factors”, “undoubtedly” or “in fact”—they should be interpreted in the context of pragmatic theory of truth.
 
2
This is also one of the reasons why I disagree with Schramme’s (2007, p. 12) claim that naturalistic concept of health can serve as a “gatekeeper against medicalization”.
 
3
Compare differences between norms of blood pressure in The Seventh Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC 8) and guidelines of the European Society of Hypertension.
 
4
Although the purpose of this article is not to enter into the dispute between the normativist and naturalist concepts of health—it should be noted that the following considerations fit the former better. Recognizing that health and disease are value-laden concepts, however, doesn’t imply that they are fully socially constructed.
 
5
I refer to Ercan Avci’s presentation at the 31st European Conference on Philosophy Of Medicine And Healthcare (ESPMH) entitled Ethical concerns resulting from the advances in life-sustaining technologies: the transformation of the “ars moriendi” to “medicalized death”.
 
6
Although the goal of this article is not to define the disease, the pragmatic framework I propose is to a certain degree consistent with the Peter Schwartz claim that “definitions of “disease” should not be seen as traditional conceptual analyses—that is, claims about the term’s current meaning or criteria for application—but instead as proposals about how to define and use the term in the future” (Schwartz 2017, p. 485). My proposition can be also seen as an addition to de Vreese’s (2017) pragmatic approach to the notion of disease.
 
7
Paraphrasing Rogers and Walker (2017, p. 421) it could be said that medicalization—just as disease—is “a vague concept” and “a matter of degree”. If we imagine the phenomenon of medicalization on a scale—as a continuum from “too little” to “too much” medicine—on one end of such a scale there would be underdiagnosis, somewhere in the middle there would be well-founded medicalization while over-medicalization (with overdiagnosis as one of its effects) would be located on the other end of the scale. Inevitably, there would be also “borderline cases that are not clearly” well-founded medicalization or over-medicalization (2017, p. 421).
 
8
Useful methods of assessing patient benefits and harms are also described in Guidance for Modifying the Definition of Diseases (Doust et al. 2017a, b).
 
9
Cancer or heart attack (and other examples of “well-founded medicalization” in Table 2) have been medicalized for such a long time, that it might be hard to imagine that they are treated and understood not as medical problems. Ethnographic studies of different traditional communities show, however, that biomedical explanations of such phenomena can co-occur with explanations of other types (Tenzel 1970; Yeo et al. 2005; Prior 2009). In some areas of the world, western medicine has to compete with traditional (e.g. religious, spiritual, shamanic) ways of coping with such phenomena as cancer. Illnesses may be still understood as a result of divine punishment, evil eye, witchcraft, bad spirits or karma—which may delay medical treatment. The four guiding questions show that the medicalization of cancer is justified because medicine can explain and cope with it better than any other social practice.
 
Literature
Blaxter, Mildred. 2010. Health, Cambridge. Polity.
Boddington, Paula. Ulla Räisänen. 2009. Theoretical and Practical Issues in the Definition of Health: Insights from Aboriginal Australia. The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine 34 (1): 49–67.CrossRef
Boorse, Christopher. 1975. On Distinction Between Disease and Illness. Philosophy and Public Affairs 5(1): 49–68.
Broom, Dorothy, and Roslyn Woodward. 1996. Medicalization Reconsidered: Toward a Collaborative Approach to Care. Sociology of Health and Illness 18: 357–378.CrossRef
Bull, Malcolm. 1990. Secularization and Medicalization. The British Journal of Sociology 41 (2): 245–261.CrossRef
Busfield, Joan. 2017. The Concept of Medicalisation Reassessed. Sociology of Health & Illness 39 (5): 759–774.CrossRef
Callahan, Daniel. 1973. The WHO Definition of ‘Health’. The Concept of Health. The Hastings Center Studies 1 (3): 77–87.CrossRef
Cash, F. Thomas. 1992. The Psychological Effects of Androgenetic Alopecia in Men. Journal of the American Academy of Dermatology 26: 926–931.CrossRef
Conrad, Peter. 2007. The Medicalization of Society: On the Transformation of Human Conditions into Treatable Disorders. Baltimore: The John Hopkins University Press.
De Vreese, Leen. 2017. How to Proceed in the Disease Concept Debate? A Pragmatic Approach. Journal of Medicine and Philosophy 42: 424–446.CrossRef
Doust, Janny, Mary Jean Walker, and Wendy Rogers. 2017a. Current Dilemmas in Defining the Boundaries of Disease. The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine. 42 (4): 350–366.CrossRef
Elliott, Carl. 2010. White Coat, Black Hat. Boston: Adventures on the dark side of Medicine, Beacon Press.
Foucault, Michel. 1973. The Birth of the Clinic. New York: Pantheon Books.
Hsu, Elisabeth. 2013. Holism and the Medicalization of Emotion: The Case of Anger in Chinese Medicine. In The Body in Balance: Humoral Medicines in Practice. Epistemologies of Healing, ed. Horden, Peregrine and Hsu, Elisabeth. Oxford: Oxford Berghahn Books.
Illich, Ivan. 2010. Limits to Medicine. Medical Nemesis: The Expropriation of Health. London: Boyars
Illich Ivan. 1976. Medical Nemesis. New York: Pantheon.
Irwig, Michael. 2012. Depressive Symptoms and Suicidal Thoughts Among Former Users of Finasteride with Persistent Sexual Side Effects. Journal of Clinical Psychiatry 73 (9): 1220–1223.CrossRef
Lemke, Thomas. 2011. Biopolitics: An Advanced Introduction. New York, London: New York University Press.
Maturo, Antonio. 2013. The Medicalization of Education: ADHD, Human Enhancement, and Academic Performance. Italian Journal of Sociology of Education 5 (3): 178–188.
Merton, Robert. 1973. The Sociology of Science: Theoretical and Empirical Investigations. Chicago: University of Chicago Press.
Moynihan, Ray, Iona Heath, and David Henry. 2002. Selling Sickness: The Pharmaceutical Industry and Disease Mongering. BMJ 324: 886–891.CrossRef
Parens, Erik. 2005. Authenticity and Ambivalence: Toward Understanding the Enhancement Debate. The Hastings Center Report 35: 3.CrossRef
Parens, Erik. 2013. On Good and Bad Forms of Medicalization. Bioethics 27 (1): 28–35.CrossRef
Payer, Lynn. 1992. Disease-Mongers: How Doctors, Drug Companies, and Insurers are Making You Feel Sick. New York: Wiley.
Pellegrino, Edmund. 2004. Biotechnology, Human Enhancement, and the Ends of Medicine. Dignitas 10 (4): 1–5.
Prior, Deborah. 2009. The Meaning of Cancer for Australian Aboriginal Women; Changing the Focus of Cancer Nursing. European Journal of Oncology Nursing 13: 280–286.CrossRef
Rogers, Wendy A., and Jean Walker. 2017. The Line-Drawing Problem in Disease Definition. The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine 42 (4): 405–423.CrossRef
Rose, Nikolas. 2007b. The Politics of Life Itself—Biomedicine, Power, and Subjectivity in the Twenty-First Century. Princeton: Princeton University Press.CrossRef
Rosecrance, John. 1985. Compulsive Gambling and the Medicalization of Deviance. Social Problems 32 (3): 275–284.CrossRef
Saracci, Rodolfo. 1997. The World Health Organisation needs to reconsider its definition of health. BMJ 314: 1409–1410.CrossRef
Schramme, Thomas. 2007. A qualified defence of a naturalist theory of health. Medicine, Health Care and Philosophy 10: 11–17.CrossRef
Schramme, Thomas, and Steven Edwards. Editors. 2017. Handbook of the Philosophy of Medicine. New York: Springer.
Schwartz, Peter H. 2017. Progress in Defining Disease: Improved Approaches and Increased Impact. Journal of Medicine and Philosophy 42: 485–502.CrossRef
Szasz, Thomas. 1970. Manufacture of Madness. New York: Dell.
Szasz, Thomas. 2007. The Medicalization of Everyday Life. Selected Essays. New York: Syracuse University Press.
Tenzel, James. 1970. Shamanism and Concepts of Disease in a Mayan Indian Community. Psychiatry 33 (3): 372–380.CrossRef
Turner, Bryan. 1995. Medical Power and Social Knowledge. London: SAGE.
Vogt, Henrik, Bjørn. Hofmann, and Linn Getz. 2016. The New Holism: P4 Systems Medicine and the Medicalization of Health and Life Itself. Medicine, Health Care and Philosophy 19 (2): 307–323.CrossRef
Yeo, Soo See, and Bettina Meiser, et al. 2005. Understanding Community Beliefs of Chinese-Australians About Cancer: Initial Insights Using an Ethnographic Approach. Psychooncology 14 (3): 174–186.CrossRef
Zola, Irving. 1972. Medicine as an Institution of Social Control. Sociological Review 20 (4): 487–504.CrossRef
Metadata
Title
How to distinguish medicalization from over-medicalization?
Author
Emilia Kaczmarek
Publication date
01-03-2019
Publisher
Springer Netherlands
Published in
Medicine, Health Care and Philosophy / Issue 1/2019
Print ISSN: 1386-7423
Electronic ISSN: 1572-8633
DOI
https://doi.org/10.1007/s11019-018-9850-1

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