GRSJ224/Medicalization of Mental Health

Summary Medicalization takes a common emotion or trait and turns it into a medical issue: bad breath becomes halitosis; impotence becomes erectile dysfunction; and sadness or grief becomes depression. There are multiple social roots for the trend, which started with unambiguous physical ills (broken bones; cancer) to progress to include human feelings and behaviour (sexuality; addiction or compulsive behaviours). On the one hand, it means that there is more research and investigation into real problems that people have. Depression and schizophrenia are very real illnesses that often require medical attention. But it has also meant an increasing intrusion into behaviour and feelings that are part of life: not all hyperactive children have ADHD and not all sad people are depressed. The social construction of what constitutes ‘normal’ behaviour and what must be treated is problematic at best. Consider that just a few decades ago homosexuality was considered a mental illness that required intensive medical treatment.

What is Medicalization Medicalization is what happens when common emotions or traits are turned into treatable conditions . This is a trend in Western-style medicine that first evolved from clear, physical illnesses that could be treated (like diabetes, asthma, or rickets). But over a long-term trend in Western medicine there has been an expansion into other areas of human life to see if human feelings and behaviours can be treated as well. This reflects an underlying philosophy towards “reductionist, somatic and- increasingly- disease-specific explanations of human feelings and behaviour” . Changing Definitions of Mental Health The problem is that defining what is ‘normal’, ‘common’ or ‘healthy’ is notoriously difficult to define. The first problem is that ‘normal’ and ‘common’ are the same, but if there are situations like wars, natural disasters, or other widespread events then depression and other issues will become common (and yet still not be normal). The other problem is that there is an assumption that life events and mental health are independent, for example children who have lost their parents have higher rates of psychiatric disorders even before the loss, suggesting that there is both a genetic predisposition and a stressful life event that trigger depression A century ago, masturbation was seen as deviant and abnormal; another ‘mental illness’ was ‘excessive female sexuality’ . The fact is that what constitutes healthy behaviour is culturally and socially defined. Socially problematic behaviour is a function of clinical, bureaucratic, administrative, and even legal contexts. Without being able to define normal in an objective sense, it becomes next to impossible to clearly define what is not normal, at least in a way that with stands the constantly changing cultural and social boundaries of a given society. Consider the relatively new ‘illnesses’ of bipolar disorder, autism spectrum disorder, and attention deficit hyperactivity disorder (ADHD) as examples of how mental health and mental un-health are socially constructed. Over the last decade in the US there has been an increase of diagnoses for these conditions of 41% . The amount of psychotropic medication for depression has increased by nearly as much- 40% . But does this mean that more people are clinically depressed, or that medicine has started to treat ‘everyday unhappiness’ with drugs? There is no real way to measure an answer to that question. Social Factors There are five main factors that have been described as contributing to the trend of increasing medicalization: 1) Health insurance- people can only be ‘treated’ if there is a diagnosis for what is bothering them 2) Death certificates and the need to describe what caused a death 3) Research funding (funding is more likely when there is a disease or condition to go with the research) 4) Drug trials 5) A “desire to wash one’s hands of blame for one’s condition” ; for example if obesity or addiction is a disease, then people do not have to fix it themselves

Social Consequences Medicalization is a process in which society and the medical community try to control something undesirable (illness, behaviour, feelings, etc.). But a major problem with this is that once someone gets the diagnosis of disease, they fall under a stigma, especially when their ‘disease’ is a socially contested behaviour. This includes a great deal of personal guilt, pain, and shame . At the same time, the extension of medical boundaries has the perverse effect of encouraging a “profound under-recognition of the suffering and breadth of mental health issues affecting millions of people” . There is another problem with medicalizing deviant behaviour. Because it is a social construct of what is ‘good’ and what is not, there are going to be cultural biases. A century ago there were cultural biases about sexuality that we no longer hold (at least to the degree that we no longer consider homosexuality a disease). In the modern era there are still significant cultural biases about class, race, religion, and ethnicity. For instance, there is enough research to show that social control and deviance are closely linked. Criminal law may be the only field in which medicalization is decreasing . Deviants with mental illness get treatment; deviants who intentionally violate the law get punishment. But the unfortunate fact is that white male offenders who commit serious crimes are far more likely to receive treatment as mentally ill than Black offenders who commit serious crimes. White criminality is labelled ‘abnormal’ while Black criminality is a personal choice .

Bibliography

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Dworkin, R. (2001, July 1). The medicalization of unhappiness. The Public Interest.

Heitzeg, N. A. (2015). 'Whiteness', criminality, and the double standards of deviance/social control. Contemporary Justice Review, 18(2), 197-214. doi:10.1080/2F10282580.2015.1025630 On the medicalization of our culture. (2009, April 23). Retrieved from Harvard Magazine: https://www.harvardmagazine.com/2009/04/medicalization-of-our-culture

Rosenberg, C. E. (2006). Contested Boundaries: pyshciatry, disease, and diagnosis. Perspectives in Biology and Medicine, 49(3), 407-424. doi:https://doi.org/10.1353/pbm.2006.0046

The PLOS Medicine Editors. (2013). The Paradox of Mental Health: Over-treatment and Under-recognition. PLOS Medicine, 10(5). doi:https://doi.org/10.1371/journal.pmed.1001456