Content area
Full Text
Social scientists and other analysts have written about medicalization since at least the 1970s. Most of these studies depict the medical profession, interprofessional or organizational contests, or social movements and interest groups as the prime movers toward medicalization. This article contends that changes in medicine in the past two decades are altering the medicalization process. Using several case examples, I argue that three major changes in medical knowledge and organization have engendered an important shift in the engines that drive medicalization: biotechnology (especially the pharmaceutical industry and genetics), consumers, and managed care. Doctors are still gatekeepers for medical treatment, but their role has become more subordinate in the expansion or contraction of medicalization. Medicalization is now more driven by commercial and market interests than by professional claims-makers. The definitional center of medicalization remains constant, but the availability of new pharmaceutical and potential genetic treatments are increasingly drivers for new medical categories. This requires a shift in the sociological focus examining medicalization for the twenty-first century.
Social scientists and other analysts have written about medicalization since at least the 1970s. While early critics of medicalization focused on psychiatry (Szasz 1970) or a more general notion of medical imperialism (Illich 1975), sociologists began to examine the processes of medicalization and the expanding realm of medicine (Freidson 1970; Zola 1972). As sociological studies on medicalization accumulated (see Conrad 1992, 2000) it became clear that medicalization went far beyond psychiatry and was not always the product of medical imperialism, but of more complex social forces. The essence of medicalization became the definitional issue: defining a problem in medical terms, usually as an illness or disorder, or using a medical intervention to treat it. While the medicalization process could be bidirectional and partial rather than complete, there is strong evidence for expansion rather than contraction of medical jurisdiction.
RISE OF MEDICALIZATION
Most of the early sociological studies took a social constructionist tack in investigating the rise of medicalization. The focus was on the creation (or construction) of new medical categories with the subsequent expansion of medical jurisdiction. Concepts such as moral entrepreneurs, professional dominance, and claims-making were central to the analytical discourse. Studies of the medicalization of hyperactivity, child abuse, menopause, post-traumatic stress disorder (PTSD), and alcoholism, among...