Medicalization as a Framework for Identity

Illustrated by Anasthasia Shilov

In modern discourse, “medicalization” has become a popular buzzword with strong negative connotations. Typically, the word is wielded within the context of over-medicalization, referring to the exponentially increasing role of pharmaceuticals in treating diseases over the last few decades. Some commonly cited examples include ADHD, sleep disorders, and infertility. Initially, however, medicalization held no such adverse undertones.

In the 1970s, Australian sociologist Peter Conrad defined medicalization as the process by which any human trait comes to be considered a medical problem requiring research, prevention, treatment, or diagnosis. By this delineation, medicalization isn’t inherently good or bad. It also isn’t a scientific problem at all—rather, it’s a social process, centered more around the perception of specific conditions than the chemistry with which they are “remedied.” Instead of focusing on how the healthcare field addresses a particular quality, medicalization indicates whether or not doctors feel the need to tackle it at all. When does deviance from the majority transition from being an expression of individuality to something that needs to be pathologized, prevented, and eradicated?

It’s nearly universally accepted that medical innovation has had an overall positive impact on global development. Indeed, there are a number of health conditions for which medical intervention is necessary; the understanding of infectious diseases, terminal illnesses, and major injuries as medically preventable and treatable has saved millions of lives. Where sociologists Irving Zola and Thomas Szasz become concerned, though, are the areas in which medicalization begins to reveal itself as a form of social control, with medicine extending its reach into parts of “everyday existence.” As discussed by Nicholas Kittrie in The Right to be Different: Deviance and Enforced Therapy, a number of “deviant” tendencies have shifted from being moral issues, to legal issues, and now to medical issues within the last century. Alcoholism, addiction, pedophilia, kleptomania, and malingering are a few examples. Prostitution and masturbation cycled through this pattern as well, until modern liberal perspectives on sex positivity gained popularity. Over time, even natural aging and death have been turned into medical issues. Although these experiences exist along a disparate scale of severity and social acceptance, each is a personal or social behavior that doesn’t always necessitate institutional involvement, but has come to be handled in that way regardless.

As a result, a number of professionals have campaigned against “disease mongering,” or the intrusive entrance of medicine into the realm of personal life. In his 1975 book, Limits to Medicine: Medical Nemesis: The Expropriation of Health, Austrian philosopher Ivan Illich expressed his fear that such a “medicalization of normality” would lead society to become unreasonably reliant on the medical field in order to cope with regular everyday life. Furthermore, many psychiatrists and social workers are worried about the unwarranted power dynamic that medicalization implies: healthcare can define, or at least consistently reflect, the social boundary between the normal and the abnormal, between the accepted and the outcast, between identity and illness. 

Historically, trends of medicalization can be traced parallel to the work of major social movements, with aspects of identity being medicalized by larger society as a mechanism of ostracizing, exploiting, and oppressing marginalized groups. Medicalization played a significant role during second-wave feminism, in a time when the male-dominated medical field was classifying menstruation, pregnancy, and menopause as medical issues and going so far as to treat them using surgery. In the 1970s, hysterectomies—the surgical removal of the uterus and supporting tissues—became the most common operation performed in the United States. Spousal abuse was also considered a medicalized problem at the time: it provided a rationalization that removed blame from the majority-male abusers. In agreement with Kittrie’s prediction, the societal understanding of homosexuality also followed the path of being defined morally, legally, and then medically. The American Psychiatric Association finally voted to discontinue defining homosexuality as an illness in 1973 in response to active protest among the queer community. This demedicalization subsequently allowed sexuality to be viewed as what it is: part of one’s identity, not an illness.

A contemporary analog to this transition can be seen in shifting societal understanding of mental health. While there is much controversy surrounding the increasing use of medication for mental illnesses, scholar Tiago Correia suggests that defining psychiatric conditions beyond their pharmaceutical treatments allows us to better see the advantages medicalization can provide. The fundamental shift of mental health into medical terms—into something that requires support and assistance rather than contempt, condemnation, and incarceration—has helped thousands of people struggling with mental illnesses. Not only does this framing allow for a higher percentage of patients with psychiatric disorders to receive care, but it also normalizes experiences like therapy. Having a mental illness does not define your identity. It becomes a condition rather than a totalizing moral judgment. In contrast, when mental health and identity are seen as intrinsically linked, stigma leads to discrimination against the individual. This negatively impacts self-esteem and intrinsic motivation to recover. In this way, the separation of mental health from identity as a result of medicalization assists people in their recovery.

While medicalization offers certain benefits, it also holds the potential to cause harm to one’s societal perception and personal identity. As a population, it’s necessary to keep this in mind going forward, reflecting on the way medicalization influences our perception of the human condition.

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