“Our adversaries are not demons, witches, fate, or mental illness. We have no enemy whom we can fight, exorcise, or dispel by ‘cure.’ What we do have are problems in living—whether these be biologic, economic, political, or sociopsychological.” – Thomas S. Szasz, M.D.
Welcome to the first of what I hope to be a number of entries on this blog, Psychiatry and Medicalization, covering topics related to psychiatry, psychotherapy, psychoanalysis, the history of psychiatry, and the broader social context of psychiatric diagnosis and classification. In particular, this blog will highlight the sociological process of medicalization as it relates to these topics.
For this first entry, I would like to take a moment to describe what is meant in sociology by the term “medicalization.” Succinctly, medicalization (and “pathologization”) refers to the process by which human problems in living come to be defined as medical, and psychiatric, diseases, and thus become the subject of medical study, diagnosis, prevention, and treatment (White, 2002). Whereas some human conditions, like heart attack and stroke, are very evidently medical in their nature, others are not as apparently so, such as alcoholism, depression, and posttraumatic stress. The study of medicalization as it relates to psychiatry seeks to understand how these latter problems become defined in medical, rather than social, moral, or psychological, terms.
Early writings on psychiatry and medicalization were authored by the psychiatrist-psychoanalyst Thomas Szasz and the sociologist Erving Goffman in the 1960s. More recently, the prominent psychiatrist Allen Frances, chairman of the DSM-IV Task Force, has revisited the question of the medicalization of normality in psychiatry. Psychiatric medicalization is a topic of considerable importance at the present, given the recent paradigmatic shift in the field towards a medical-biological approach and away from a psychosocial one, occurring in roughly the past 40 years. This trend has major ramifications in terms of “treatment,” symbolized by a shift away from the talking therapies and towards psychiatric drugs and other physical interventions.
An example of what has been considered medicalization in psychiatry is the progressive transmogrification of childhood misbehavior and inattention—which in most cases is grown out of by adolescence and adulthood—into “attention-deficit hyperactivity disorder.” Much has been written on this topic, and I will not belabor this point here, but the condition now known as ADHD was not a diagnosable disorder until the mid-to-late 20th century. Hyperactive children of course existed before this time, but they were not considered medically disordered or diseased. Since there was no discovery of brain pathology and remains no biological test for ADHD, the classification of childhood hyperactivity as a psychiatric disorder was a social activity, not a medical one. The study of psychiatric medicalization seeks to understand how these processes occur and the nature of their consequences—social, political, economic, and psychological.
An important distinction must be made at the outset of this blog. There are some psychiatrists, psychotherapists, and social theorists who argue that psychiatry has fallen victim to medicalization—that some more recent additions to the diagnostic manual are nonmedical problems but that other diagnostic entities are genuine medical diseases. There are others, most notably Szasz, who contend that psychiatry is medicalization, through and through. To these theorists, psychiatry has functioned from its beginning as the domain of patients said to be ill but lacking in medical disease. I tend to agree with the latter proposition, with few exceptions.
I wish also to note at the outset of this blog that the assertion that mental illness is a literalized metaphor (and that psychiatric conditions are medicalized problems in living) does not discount or downplay the suffering of people diagnosed as mentally ill. Many of these persons suffer gravely, and their symptoms are real enough. The point in discussing psychiatric medicalization is to consider the very many forces influencing this process and to discuss its consequences in terms of helping suffering people.
I look forward to writing this blog and hope that you will follow along.
White, K. (2002). An introduction to the sociology of health and illness. Thousand Oaks, CA: SAGE.