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In the form of an essay, discuss the concept of medicalization (and if appropriate de-medicalisation) and some of the possible consequences of medicalization using one example of medicalization.
Lecture slides
Medicalisation consists of defining a problem [not previously seen as medical] in medical terms, using medical language to describe a problem, adopting a medical framework to understand a problem, or using medical intervention to treat it.2 At a conceptual level medicalisation entails defining problems through medical vocabulary. Institutionallevel medicalisation occurs when organisations adopt medical approaches to treating particular problems. At an interactional level, physicians may medically diagnose a patients problems or offer medical treatment (e.g. tranquilisers for a social problem such as an unhappy family life or grief).3 Benefits of medicalization: medical treatments can remove/reduce suffering. Individuals and groups can also benefit from medicalisation in so far as being ill is generally viewed more sympathetically than being sinful or bad, for example: in alcoholism, the process of medicalisation removes culpability: a persons problems can be ascribed to a chemical imbalance rather than as reflecting his or her character or accomplishments. Critiques 1. Pathologise everyday life. Zola (1972) argued if anything can be shown in some way to affect the workings of the body and to a lesser extent the mind then it can be labeled an illness itself or jurisdictionally a medical problem. Thus even normal physical conditions such as menstruation, pregnancy and childbirth, body and facial shape and size, ageing and sexuality have been brought under medicines jurisdiction. 2. Emphasize individual rather than social causes for problems.
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3. Medicalisation and economic interests. Part of the sociological critique of medicalisation is focused on the possible alignment between the medical profession, medicalisation and the economic interests of pharmaceutical and biotechnology companies. 4. Iatrogenesis. Medicalisation may lead to increased iatrogenesis. Iatrogenesis is defined as the development of new health problems as the result of treatment for existing health problems. Xanax addiction. Ivan Illich 1974 claimed that medical practice was a threat to health, identified a syndrome he called medical nemesis or iatrogenesis. Depression, infection, disability, dysfunction, and other specific iatrogenic diseases now cause more suffering than accidents (1974:74). 5. Concern about the increasing power of medicine. Social control 6. Narrowing range of normal. The range of behaviours viewed as desirable or normal is narrowed. This reflects the attitudes and priorities of dominant social groups. Individuals or groups who fall outside of dominant categories of normal/desirable are particularly culnerable to medicalisation. 7. Medicalisation and gender De-medicalisation
Draw on Foucault here -> In modern times, those who possess knowledge and potent communication skills can exert power over others, and Western societies dependence on medical expertise deprives the layperson of their ability to cope with their own problems (Nettle ton, 2006; Wilkinson &Miers, 1999;
Zelek &Phillips, 2003). Given doctors power and their control over the medical affairs of their patients, one can begin to see how medicalisation has become such a powerful force. It has been suggested that simply medicalising unhappiness, as evidenced by the over-prescription of antidepressants, reflects a
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societal need for a quick fix and a lack of a clear definition for mental disorders (Dworkin, 2001; Horwitz &Wakefield, 2007; Kirsch et al., 2008; Parker, 2007).
Multi dimensional 228 Multi dimensional 228 8 Multi dimensional 229 9 Multi dimensional 237 10 Multi dimensional 238 11 Medicalization of sadness 165 12 Medicalization of sadness 165
and Wakefield (2007) propose that besides bereavement, there are many other types of loss and adverse events 13 that can trigger deep but normal sadness that also need to be taken into account.
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Medicalization of sadness 166 Social control 209 15 Social control 210 16 Social control 212 17 Social control 214 18 Social control 216 19 Social control 223 20 Social control 223-224
In general, sociologists remain skeptical about medicalization, although ambivalent in the recognition of certain gains and losses (Riessman 1983).21 It may now be the right moment to focus more directly on investigating the structural underpinnings of medicalization, especially given the enormous changes occurring in medical organization and knowledge, and to expand our lens to examine cross-cultural dimensions of medicalization.22
An epidemic of depression
I argue that major depression is not a natural entity and does not identify a homogenous group of patients. The apparent increase in major depression results from: confusing those who are ill with those who share their symptoms; the surveying of symptoms out of context; the benefits that accrue from such a diagnosis to drug companies, researchers, and clinicians; and changing social constructions around sadness and distress.23 Health care systems are criticized for failing to provide even minimally adequate treatment for the majority of individuals who suffer from depression (Sanderson et al. 2003).24 Mental illness may be a reconceptualization of what, in other eras, would have been seen as weakness, bad habits, or sin.25 The American Psychiatric Associations Diagnostic and Statistical Manual (DSMIV) concept of major depression is regarded as an expression of medical naturalism (APA 1990). DSM-IV presents depression as a distinct and recognizable medical syndrome. It lists nine symptoms of which five or more-including depressed mood and/or anhedonia-must be present during the same two-week period. Individuals are either diagnosed with major depression or they are not. While the general introduction to DSM-IV concedes that all its illness definitons are human constructions (p. xxxi), most mental health workers view depression as a specific mental illness, a natural entity rather than an arbitrary construction.26
THE INCIDENCE OF MAJOR DEPRESSION Epidemiological studies consistently report that DSM major depression has increased markedly during the latter half of the 20th century. Successive population cohorts since World War II have reported increasing rates of depression and earlier onset of the illness (Weissman et al. 1996). Depression is now considered a major public health challenge affecting around 15% of men and 24% of women (Hirschfeld et al. 1997).The World Health Organization (2007) estimates that by 2020 27 depression will be second in the International Burden of Disease ranking. There are four principle explanations for this. The first is that there is an epidemic of the illness major depression. The second explanation is that the depression epidemic is an artifact related to the DSM criteria.*read more here*
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Social control 224 Social control 228 23 Epidemic 238 24 Epidemic 238 25 Epidemic 239 26 Epidemic 239 27 Epidemic 240
The third explanation is that those with incentives, particularly financial ones, have elevated rates of major depression because it serves their interests. These incentives are particularly powerful for drug companies to improve their sales and profits. Drug companies attempt to expand their market for depression as for all medical illnesses, and they sponsor depression awareness campaigns, medical education, depression carer meetings, and conferences. This may be seen as effectively giving important information to the public and doing great good, or alternatively, as largely self-serving. Drug companies 28 also clearly influence the prescribing habits of doctors (Lexchin 1993; Wazana 2000). The fourth explanation returns to the debate around conceptualizing psychopathology. This viewpoint considers the increase in depression to be a social construction, with the symptoms of depression residing in the cultural rules defining what is normal and abnormal, and the rules varying in different historical eras. At present, lack of motivation, low energy, unproductivity, and persistent unhappiness are th th conceptualized as illness. In the 18 and 19 centuries, however, similar symptoms may have been 29 conceptualized as somatic or social ailments. The social constructionist argument is difficult to develop Inappropriate medicalization may help feed unhealthy obsessions with health. Illness models tend to focus on individualized, pharmacological, and private solutions rather than sociological or political 30 explanations for health problems (Moynihan, Heath, and Henry 2002).
Essay Plan
Intro P1. Definition, history background P2. Medicalisation of sadness/depression P3. Focus on Pharmaceuticals Conclusion
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