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The Medicalization of Everyday Life. Selected Essays.

2008; Elsevier BV; Volume: 72; Issue: 5 Linguagem: Inglês

1553-6467

Michael Montagne,

Mental Health and Psychiatry

The medicalization thesis, the re-labeling or redefining of a personal or social problem as a medical condition thus requiring therapeutic intervention, has become the focus of a number of recent works. In the late 1960s and early 1970s, researchers, mostly social scientists, were studying issues surrounding social control and a range of human problems that had come under medical jurisdiction. Three researchers were at the forefront of this new area of inquiry, building a career on it: Peter Conrad, Ivan Illich, and Thomas Szasz. Each tended to focus on certain aspects of medical care and control: patients' experiences with certain diseases, the politics of medicine, and the true nature of psychiatry. The psychiatrist, Thomas Szasz, has written about medicalization in psychiatry since the 1970s, arguably even earlier. This collection of previously published essays, which appear in adapted form, recounts his lifelong interest in medicalization. These essays are presented in 2 sections: 7 of them are part of the first section, entitled “Demarcating Disease from Nondisease,” and 9 are part of the second section, entitled “Disturbing Behavior and Medicine's Responses to It.” The original publication dates of these essays range from 1973 to 2006. In both a preface and introduction, Szasz comments on the term medicalization and what it means today. Szasz's key argument is that social groups seeking to exercise power and control subvert the diagnostic process, resulting in the treatment of non-disease as disease. He believes, at least in psychiatry, “that we are not dealing with real, literal diagnoses, diseases, or treatments. We are dealing with the metaphorical uses of these terms” (emphasis his). The essays herein detail various aspects of his central thesis: mental illness is not a disease. To the extent that psychiatry, medicine, and patient advocacy groups have defined certain behaviors as psychiatric diseases, the medical establishment then forms an alliance with the political state to gain power over individuals with the purpose of controlling those behaviors. The ultimate result is a therapeutic state that rules over all human behavior in the context of biomedical disease to the exclusion of any individual right or personal freedom. He also differentiates between medicalization from above (coercion) and medicalization from below (choice), reflecting again his concern for ever diminishing personal freedoms. According to Szasz, “medicalization is not medicine or science; it is a semantic social-strategy that benefits some persons and harms others.” The ultimate expression of his thought is found in the final essay, “Pharmacracy: The New Despotism,” originally published in 2001. There is little support in psychiatry for Szasz's views. For that matter, many people become very argumentative, often hostile, when his viewpoints are brought up for discussion. While certainly extreme, even in comparison to other scholars on this topic, his work warrants attention. It should be read and discussed in context with similar works: Ivan Illich, Medical Nemesis (1976); Lynn Payer, Disease Mongers (1992); Ray Moynihan and Alan Cassels, Selling Sickness (2006); and Peter Conrad's recent collection of essays, The Medicalization of Society (2007). Szasz's book is best used in graduate courses, specialized seminars, and by researchers and faculty members wishing to gain a more thorough understanding of the medicalization thesis. Use of the medicalization thesis to argue about the nature of disease and medical treatment in contemporary society seems to entail a number of interrelated issues. How do we distinguish or demarcate a disease from a non-disease? Attendant to that, when is a specific disease's diagnostic criteria clear enough and bounded such that most everyone would agree it is unambiguously a disease? How then do we explain or help individuals who present with negative changes in their bodies and minds, feelings of being not healthy, essentially “symptoms” that suggest what if not a disease? There are many interesting ideas and testable hypotheses floating around in these works on medicalization. It is time for more serious attention and focused research on this topic.