Abstract
This is a most important book. The message is for society in general, but because the medical profession is deeply implicated it deserves special consideration by this group.
This short book is clearly written, the author is a sociologist who has been contributing on this topic for more than three decades. It is authoritative and well referenced. It gives line and verse on erectile dysfunction, social phobia, adult attention-deficit disorder, baldness, cosmetic surgery, anti-ageing treatment (now termed ‘age management’), short stature and obesity. It also gives valuable insights into the medicalization of masturbation, homosexuality, excessive alcohol use, and childbirth.
Medicalization is the process by which non-medical problems become defined and treated as medical problems. The process depends on many factors, some more sinister than others. Social commentators need to understand that the major goal of the medical profession is to reduce the suffering of the individual. And that is a good and noble goal. The medical profession needs to understand, however, that medicalization simply cannot work, and has serious social consequences.
In 1976 Illich blamed this process on ‘medical imperialism’ [1]. I always found that view obnoxious. I worked in an addiction hospital and knew that alcoholism was accepted as a medical disorder only after sustained pressure from Alcoholics Anonymous. Conrad is among the first to refute Illich, instead identifying ‘an increasingly complex interplay of various social actions’.
Among the ‘drivers’ of medicalization are the pharmaceutical companies, and Conrad explains the tactic of first marketing a disorder (shyness, impotence) and then marketing the treatment (Paxil, Viagra). Other ‘drivers’ are support groups (Children and Adults with Attention-Deficit–Hyperactivity Disorder), which are facilitated by the Internet and, often, money from pharmaceutical companies. Conrad explains that self-labelling provides a new public identity and a legitimate claim to disability entitlements. The doctor retains the role of gatekeeper, but it is difficult to keep the gate against determined individuals well-informed by Internet sources. On the topic of adult attention-deficit–hyperactivity disorder and similar, Conrad coins the phrase ‘medicalization of underperformance’.
This book contains much thought-provoking material. The point is made that the provision of human growth hormone to the shortest 1.2% of children will create an ever-increasing pool of customers. The latest National Comorbidity Survey is mentioned because of the claim that nearly half the population will satisfy the criteria of a mental disorder at some time in their lives. The repost is made that standardized and ‘decontextualized questions’ about symptoms do not distinguish the normal experience of distress in response to negative life events from genuinely pathological conditions. This welcome point has also recently been made by Horwitz and Wakefield [2].
Conrad believes that medicalization has led to many of life's problems being cast as disorders and that, in large part, this is because we have become less tolerant to mild symptoms and relatively benign problems.
One difficulty that medicalization creates is the feedback loop of our ever-reducing tolerance of difficulty. Medicalization cannot work because the individual receives the treatment, but it is the society that needs to change. The effort is being applied at the wrong place. On a more esoteric level, Conrad points out that medicalization is reducing our appreciation of the diversity of human life. He makes the chilling claim that the pharmaceutical industry is defining what is normal, expected and acceptable in society.
Unfortunately, the medicalization of suicide is not mentioned.
This is an authoritative, easy-to-read book on a very important topic. It will be of great interest to students, but hopefully those in the higher echelons of the profession and their policy makers will take time to ponder the messages.