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Week 6: Medicalization New illnesses In the last several decades, more and more aspects of life in post- industrial societies are treated by medicine

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Week 6: Medicalization New illnesses In the last several decades, more and more aspects of life in post- industrial societies are treated by medicine. New disease categories and medicalization Why is this occurring? Is there an epidemic of new medical problems? • Has biomedicine become better able to identify and treat existing problems? • What social factors underlie this expansion of medicine? • What is the process of medicalization? There is no single process of medicalization. Issues include: • Decreased focus on religion & the rise of faith in science/progress What is the process of medicalization? There is no single process of medicalization. Issues include: • Decreased focus on religion & rise of faith in science/progress • Increased prestige & power of biomedical profession What is the process of medicalization? There is no single process of medicalization. Issues include: • Decreased focus on religion & rise of faith in science/progress • Increased prestige & power of biomedical profession • • Decreased tolerance for mild symptoms and focus on enhancement What is the process of medicalization? There is no single process of medicalization. Issues include: • Decreased focus on religion & rise of faith in science/progress • Increased prestige & power of biomedical profession Decreased tolerance for mild symptoms and focus on enhancement • American penchant for individual/tech solutions • • What is the process of medicalization? There is no single process of medicalization. Issues include: • Decreased focus on religion & rise of faith in science/progress • Increased prestige & power of biomedical profession Decreased tolerance for mild symptoms and focus on enhancement • American penchant for individual/tech solutions • In?uence of pharmaceutical industry • • What is the process of medicalization? There is no single process of medicalization. Issues include: • Decreased focus on religion & rise of faith in science/progress • Increased prestige & power of biomedical profession Decreased tolerance for mild symptoms and focus on enhancement • American penchant for individual/tech solutions • In?uence of pharmaceutical industry • Managed care and in?uence of third party payers • • So what are the consequences of increased “discovery“ of medical conditions? Remember… We talked about the ways in which biomedicine understands disease: • Observable through signs in the body • Amoral (not good or bad) • Separate from human relationships • A result of natural rather than supernatural processes, Medicalization of Deviance What are the consequences of de?ning a problem in medical terms and using medical intervention to “treat” it? • Medicalization of deviant behavior • How is deviance determined? Examples: • Addiction/alcoholism • Social anxiety disorder • ADHD Medicalization of Deviance Attention De?cit Hyperactivity Disorder; diagnosis expanding from children to adults Childhood ADHD Prevalence, 2011-2012 Social context: • “Prozac era”: drugs not just for the seriously disturbed; might improve functioning for anyone • Managed care: limits on psychotherapy reimbursement; reliance on prescription meds Consequences: • Legitimates issue & opens sick role • But does it rede?ne “normal” & create new de?nitions of disability? Medicalization of Deviance Example: “Beyond the Medical Model: Rethinking Autism” Surveillance Medicine The medicalization of deviance (for example, in ADHD or Autism) is part of the rise of what David Armstrong calls “surveillance medicine” in the 20th century • Focused on the “norm” • Example: Child growth charts; Abnormality is relative, in reference to other children • This blurs the distinction between health and disease; no longer a strict binary Surveillance Medicine Consequences of surveillance medicine • Medicine doesn’t just focus on the sick. Everyone is the target of medical monitoring and intervention • Concept of the “risk factor” opens up a space of future illness potential Surveillance Medicine Consequences of surveillance medicine • Medicine doesn’t just focus on the sick. Everyone is the target of medical monitoring and intervention • Concept of the “risk factor” opens up a space of future illness potential • Internalization by the population; we are all encouraged to monitor ourselves to maintain health Surveillance Medicine: Enhancement Consequences of surveillance medicine • Reframing of understanding of health; we could all be healthier/better “Enhancement” technologies: Prozac, Viagra, cosmetic surgery, Botox injections, diet drugs, etc. • Blurred line between enhancement and treatment • Is this positive self-improvement or the medicalization of socially undesirable human variation? Surveillance Medicine: Wellness Consequences of surveillance medicine • Avoiding disease and illness, being as health as possible, is a virtue • “Wellness” as a matter of personal responsibility • We are all encouraged to monitor ourselves and seek treatment if necessary to achieve wellness What might be missing in this approach? Medicalization of the Life Cycle Pregnancy & Childbirth • Until the 20th century, most U.S. births took place at home and were attended by midwives • 18th century: wealthy women who could a?ord to began to invite physicians to attend to them in childbirth • 19th century: medicalization intensi?ed; linked to rise of hospitals, bacteriology, social changes like urbanization and industrialization Medicalization of the Life Cycle Pregnancy & Childbirth •Many changes came with medicalization •Midwifery was outlawed in many places •Changes in delivery positions •Increase in procedures and tools that make birth easier for physicians Anti-midwife Propaganda •Technological monitoring, rather than reliance on how woman is feeling •Women come to know less about childbirth Medicalization of the Life Cycle Pregnancy & Childbirth But this isn’t simply “medical imperialism” • Access to medicalized birth also seen as a woman’s right • Many women seeking medical expertise to prevent death in childbirth • “Twilight sleep” and other pain control methods seen as providing women with more control Medicalization of the Life Cycle Pregnancy & Childbirth Although childbirth is almost completely medicalized today, home birth and natural birth movements are growing in the United States What is behind this antimedicalization movement? Medicalization of the Life Cycle Kaufman et al., Biomedicalization of Aging • Aging is constructed as a pathology and medicine as the right (and only) way to deal with aging • We have lost our sense of the natural life cycle • Increasingly di?cult to say no to life-extending interventions Medicalization of Social Problems But medicalization could also be used to highlight structural issues behind social problems Example: What are the consequences of viewing drug addiction and overdose as a health issue? Example: What are the consequences of viewing gun violence as a health issue? view here: http://www.youtube.com/watch?v=j6bmZ8cVB4o David Rosenhan’s paper On Being Sane in Insane Places, was published in the journal Science in 1973. Oops -- He overstated the case! (He should have shown the positive examples). Laing (1967) saw psychosis as "a special strategy that a person invented in order to live in an unlivable situation" (p. 115). What is wrong in so-called schizophrenia is not "in the patient" but rather in his family and in society. Insanity, Laing insisted, is an understandable and rational adjustment to an insane R.D. Laing [right] who was one of the leaders of “antipsychiatry” movement which held that psychiatry was a fake science whose world. categories had no basis in reality, and that was used as a system of political control over those who wanted to break free from a violent collapsing society. Obeyesekere raises questions about psychiatric pathologization and “cultural difference” ” He cites a text about depression among British women that reads: “The immediate response to loss of an important source of positive value is likely to be a sense of hopelessness, accompanied by a gamut of feelings, ranging from distress, depression, and shame to anger. Feelings of hopelessness will not always be restricted to the provoking incident -- large or small. It may lead to thoughts about the hopelessness of one’s life in general. It is such generalization of hopelessness that we believe forms the cenral core of depressive disorder. (Brown and Harris 1978:235) Obeysekere replies: “This statement sounds strange to me, a Buddhist, for if it was placed in the context of Sri Lanka, I would say that we are not dealing with a depressive but a good Buddhist. ..” and describes Sri Lankan society as one “whose predominant ideology of Buddhism states that life is suffering and sorrow” Medical anthropologist Emily Martin, in her ethnography “Bipolar Expeditions” traces the perceptions of mania and madness in U.S. culture, and the ways in which psychiatry is shaped by larger social forces, while also acknowledging the great benefit that pharmaceutical prescriptions can bring patients. This more nuanced, political-economic type of analysis is neither anti-psychiatry nor in defense of it; it uses cultural analysis to understand how it can serve more people better. Geel: Belgium 7th century CE, Dymphna, patron saint of the mentally ill, epileptics, and of abused children Geel, Belgium: a changing tradition Documentary 1973 Different abilities In what ways can disease, illness, and the body be sites of social control? In what ways can disease, illness, and the body also be sites of resistance and power?