The Medicalization of Aging Bodies

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Image from Anastasia Pottinger's compilation of centenarian portraits

Medicalization refers to a sociocultural process in which a phenomenon comes to be defined and treated as a medical problem.[1] The process whereby aspects of human life are subsumed under medical jurisdiction was construed by Irving Zola as a reflection of the medical establishment becoming an institute of social control.[2][3] Initially applied to behaviours and phenomena deemed socially deviant, the medicalization framework has now been applied to various life processes.[4]

Within a society, the medicalization of aging bodies is reflected in institutional practices which oftentimes reflect a cultural emphasis on the biomedical model and can result in the oppression of aging individuals.[5] However, despite the universality of aging as a biological phenomenon, structural and cultural factors that promote the medicalization of aging bodies are not experienced uniformly. In considering individual experiences with aging it is necessary to consider intersectionality, a term coined by Kimberle Crenshaw to explain how individual experiences with oppression are a product of an interaction between the multiple identities one holds combined with social environment within which one is situated.[6] In the context of aging, an intersectional framework is crucial to adopt given that individuals' experiences with aging interact with other identities they hold.[7]

The Role of the Biomedical Model

Image from Regenexx website

Caroll Estes and Elizabeth Binney point to the medicalization of aging as a downstream effect of a cultural emphasis on the biomedical model and highlight how this view places the onus of aging on the individual and promotes medical management.[5][1]

The focus on individual responsibility in the aging process that Estes and Binney[5] attribute to societal emphasis on the biomedical model has been referred to as the “ethos of responsibility"[8] and places the maintenance of health and youthfulness in old age as a goal that one can achieve through taking appropriate actions such as through diet and exercise.[8] This view is capitalized on by anti-aging culture and resembles the model of “successful aging” laid out by Rowe and Kahn in their 1998 book.[8][9]

The model of aging is potentially harmful in that it ignores the social and structural inequalities within which individual's experiences of aging are situated.[8][9] It also neglects to consider other aspects of individuals' unique experiences. For example, the model has been criticized for ignoring the experiences of individuals aging with a disability,[9] the implications of which vary depending on one's gender, race, and class.[10]

Anti-Aging Culture

Infographic depiction of successful aging that supports the notion of aging as a personal responsibility

In Western society, ageism and cultural endorsement of values that emphasize youthfulness have given rise to a media landscape and social institutions that reflect an anti-aging ideology[11] thus making the term "anti-aging culture" applicable.[12]

In the context of aging, bodily changes that occur as one ages become a target for medicalization.[13] As such, the aging body becomes a target for scrutiny and intervention. This can be seen in instances where Western media presents the aging body as a sign of disease which one must actively treat.[14][15] These representations reinforce the notion of "successful aging" as do institutions such as the American Academy of Anti-Aging Medicine (A4M) and other establishments that make up the anti-aging industry.

Examples of Medicalized Age-Associated Bodily Conditions and The Available “Treatments”
Condition Treatment
Aging Skin    Botox injections, chemical peels, microdermabrasion, sclerotherapy and laser skin treatments[11]    
Aging Faces    “Rejuvinative” cosmetic surgery such as liposuction, eyelid rejuvenation, facelifts, browlifts, and laser resurfacing[16]
Menopause    Hormone replacement therapy[17] 
Low Bone Density Antiresorbative or anabolic drug therapy, calcium and vitamin D supplementation[18][19]
Andropause    Testosterone supplementation[13]
Balding/Male-Pattern Hair Loss    Drug treatment (eg. Rogaine, Propecia), hair transplant[13]
Erectile Dysfunction    Drug treatment (eg. Viagra)[20]

Individual Experiences

Gender, Race, Sexuality and Aging Bodies

Gender is one aspect of identity that is particularly relevant to medicalization as women’s bodies have historically been subject to the brunt of medicalization.[21] For instance, many normative experiences related to female reproductive physiology such as menstruation, pregnancy, childbirth, and menopause have undergone medicalization.[22] Given that the beauty industry disproportionately targets females, it comes as no surprise that aging women are the main targets of the anti-aging cosmetic industry.[11] In fact, the term “the double standard” has been used to describe the way in which men often become seen as more attractive with age whereas the opposite is true for women.[23] It should be noted however, that aging men are also affected by medicalization, as evidenced by the medicalization of conditions such as baldness, erectile dysfunction, and andropause.[4]

Age and gender interact with numerous other identities individuals hold and contribute to lived experiences of oppression. For instance, the interaction between sexuality, age, and gender is demonstrated by evidence that aging gay men may struggle more with coming to terms with their own aging body than heterosexual men.[24] Concern with aging appearances also varies by race and class, a phenomenon supported by the finding that African American men and women as well as individuals of lower socioeconomic status are more accepting of aging bodies.[24] There is also evidence to suggest that lesbian women may experience less distress than heterosexual women around age-associated bodily changes.[25] These divergent experiences highlight how counter cultural norms may in some cases protect against institutional sources of oppression promoted by the anti-aging industry.

The Young-Old, the Old-Old, and the Third and Fourth Ages

Class is an aspect of identity that has long been recognized as central to individual experiences of aging. For instance, the terms “young-old” and “old-old” were invoked by Bernice Neugarten in 1974 to denote the existence of two identifiable subsets of aging individuals with divergent experiences of aging based largely on affluence.[26][23] In a similar vein, the terms “third age” and “fourth age” were used by Peter Laslett in 1989 to distinguish divergent experiences of aging among individuals on the basis of demographic conditions.[27][23]

Decentralizing Identity

The disparate experiences of aging individuals illustrate how the medicalization of aging bodies and the associated oppression are not experienced equally. It is therefore necessary to decentralize the oppression associated with aging from the identity itself and consider the broader sociocultural context. While personal experiences and institutional practices are undoubtedly connected, an intersectional framework provides evidence of the role both play in determining individual experience. While institutional forces that support the anti-aging industry may promote the oppression of aging individuals, individual experiences of living with an aging body in an anti-aging culture depend on the other identities an individual holds and the forms of oppression or protection those identities confer.[7]

  1. ↑ 1.0 1.1 Conrad, P. (1992). Medicalization and social control. Annual Review of Sociology, 18(1), 209-232. doi:10.1146/annurev.so.18.080192.001233
  2. ↑ Zola, I. K. (1972). Medicine as an institution of social control. The Sociological Review, 20(4), 487-504.
  3. ↑ Clarke, A., Shim, J., Mamo, L., Fosket, J., & Fishman, J. (2005). Biomedicalization: Technoscientific transformations of health, illness, and U.S. biomedicine. In P. Conrad (Ed.), The sociology of health and illness: Critical perspectives. (7th ed., pp. 442-455). New York, NY: Worth.
  4. ↑ 4.0 4.1 Conrad, P. (2007). The medicalization of society: On the transformation of human conditions into treatable disorders. Baltimore: Johns Hopkins University Press.
  5. ↑ 5.0 5.1 5.2 Estes, C. L., & Binney, E. A. (1989). The biomedicalization of aging: Dangers and dilemmas. The Gerontologist, 29(5), 587-596. doi:10.1093/geront/29.5.587
  6. ↑ Crenshaw, K. (1998). Demarginalizing the intersection of race and sex: a black feminist critique of antidiscrimination doctrine, feminist theory, and antiracist politics. In A. Philips (Ed.) Feminism and politics (pp. 314-343). Oxford, NY: Oxford.
  7. ↑ 7.0 7.1 Dressel, P., Minkler, M., & Yen, I. (1997). Gender, race, class, and aging: advances and opportunities. International Journal of Health Services, 27(4), 579-600.
  8. ↑ 8.0 8.1 8.2 8.3 Cardona, B. (2008). ‘Healthy ageing’ policies and anti-ageing ideologies and practices: On the exercise of responsibility. Medicine, Health Care and Philosophy, 11(4), 475-483. doi:10.1007/s11019-008-9129-z
  9. ↑ 9.0 9.1 9.2 Stowe, J. D., & Cooney, T. M. (2015). Examining rowe and kahn's concept of successful aging: Importance of taking a life course perspective. The Gerontologist, 55(1), 43. doi:10.1093/geront/gnu055
  10. ↑ Warner, D. F., & Brown, T. H. (2011). Understanding how race/ethnicity and gender define age-trajectories of disability: An intersectionality approach. Social science & medicine, 72(8), 1236-1248.
  11. ↑ 11.0 11.1 11.2 Hurd Clarke, L. (2011). Facing age: Women growing older in anti-aging culture. Lanham, MD: Rowman & Littlefield.
  12. ↑ Katz, S. (2001). Growing older without aging? positive aging, anti-ageism, and anti-aging. Generations-Journal of the American Society on Aging, 25(4), 27-32.
  13. ↑ 13.0 13.1 13.2 Szymczak, J. E., & Conrad, P. (2006). Medicalizing the aging male body: Andropause and baldness In Rosenfeld and C. A. Faircloth (Eds.). Medicalized masculinities. (pp.89-111). Philadelphia, PA: Temple University Press.
  14. ↑ Kampf, A., & Botelho, L. A. (2009). Anti-aging and biomedicine: Critical studies on the pursuit of maintaining, revitalizing and enhancing aging bodies. Medicine Studies, 1(3), 187-195. doi: 10.1007/s12376-009-0021-9
  15. ↑ Rozanova, J. (2010). Discourse of successful aging in The Globe & Mail: Insights from critical gerontology. Journal of aging studies, 24(4), 213-222. doi: 10.1016/j.jaging.2010.05.001
  16. ↑ Honigman, R., & Castle, D. J. (2006). Aging and cosmetic enhancement. Clinical interventions in aging, 1(2), 115-119.
  17. ↑ Bell, S. E. (1987). Changing ideas: The medicalization of menopause. Social science & medicine 24(6), 535-542. doi: 10.1016/0277-9536(87)90343-1
  18. ↑ Black, D. M., & Rosen, C. J. (2016). Postmenopausal osteoporosis. New England Journal of Medicine, 374(3), 254-262.
  19. ↑ Santora, L., & Skolbekken, J. A. (2011). From Brittle Bones to Standard Deviations: The Historical Development of Osteoporosis in the Late Twentieth Century. Science, Technology, & Human Values, 36(4), 497–521. https://doi.org/10.1177/0162243910366152
  20. ↑ Katz, S., & Marshall, B. (2003). New sex for old: Lifestyle, consumerism, and the ethics of aging well. Journal of Aging Studies, 17(1), 3-16. doi:10.1016/S0890-4065(02)00086-5
  21. ↑ Riska, E. (2003). Gendering the medicalization thesis. In  M. T. Segal, V. Demos, & J.J. Kronenfeld (Eds.). Gender Perspectives on Health and Medicine (Advances in Gender Research, Volume 7) (pp. 59-87) doi:10.1016/S1529-2126(03)07003-Riska, E.
  22. ↑ Rostosky, S. S., & Travis, C. B. (2000). Menopause and sexuality: Ageism and sexism unite. In Sexuality, society, and feminism. (pp. 181–209). Washington, DC: American Psychological Association. https://doi-org.ezproxy.library.ubc.ca/10.1037/10345-008
  23. ↑ 23.0 23.1 23.2 Settersten, R. A. (2017). Some things I have learned about aging by studying the life course. Innovation in Aging, 1(2).doi:10.1093/geroni/igx014
  24. ↑ 24.0 24.1 Calasanti, T & King, N. (2015) Intersectionality and age in J. Twigg, & W. Martin (Eds.). Routledge handbook of cultural gerontology (pp. 193-200). Routledge.
  25. ↑ Clarke, L. H., & Korotchenko, A. (2011). Aging and the body: A review. Canadian Journal on Aging, 30, 495-510. doi:10.1017/S0714980811000274
  26. ↑ Neugarten, B. L. (1974). Age groups in american society and the rise of the young-old. The Annals of the American Academy of Political and Social Science, 415(1), 187-198. doi:10.1177/000271627441500114
  27. ↑ Laslett, P. (1989). A fresh map of life: The emergence of the third age. London: Weidenfeld and Nicolson.
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