July 2015 Pulse
Without a doubt, the advances of modern Western medicine have benefited society in many ways. From vaccinations against debilitating but preventable diseases to targeted cancer therapies, modern medicine has contributed to the unprecedented decline in mortality and improved the lives of people in many parts of the world today. Christians must see medicine as an outworking of what some theologians have called the common or universal grace of God.
However, like all human enterprises, medicine has to do with culture as much as it has to do with science. Modern medicine has changed the way in which we understand disease, health, normality and disabilities. In other words, medicine has introduced paradigmatic shifts in the way we understand ourselves.
The predominance and success of medicine in modern society have resulted in the over-medicalization of the latter, a phenomenon that has attracted the attention of scholars since the 1950s. The medical sociologist Irving Zola defines medicalization as a process in which more and more aspects of daily life are brought under medical influence and control. Philosopher Sergio Sismondo sharpens Zola’s broad definition by describing medicalization as ‘the turning of non-medical problems into medical ones.’
Examples abound in the growing literature on this phenomenon. In a 1987 Gallup Poll, 89% of Americans concurred with the statement that ‘alcoholism is a disease.’ The proliferation of pharmaceutical substances used in the ‘treatment’ of alcoholism has changed in a way in which society perceives this problem, resulting willy nilly in its medicalization.
Or take the case of shyness. For a long time social reticence is seen as part of the normal range of human personality. However, when the pharmaceutical giant GlaxoSmithKline promoted the drug Paxil as the treatment for ‘social anxiety disorder’ (SAD), what was once a rare psychiatric condition is now seen as a common malady. Consequently, according to one report, one in eight Americans suffers from this condition.
Deviant behaviours ranging from hyperactivity to criminality are also viewed through the lens of medicalization. The medicalization of deviance, writes A. V. Horwitz, ‘refers to the tendency to define deviance as a manifestation of an underlying sickness, to find the causes of deviance within the individual rather than in the social structure, and to treat deviance through the intervention of medical personnel.’
In the past, doctors played a significant role in the medicalization process. But now consumers, insurers and the biotechnological industry are driving the process.
The biotechnological industry has become the main force behind what scholars call ‘economic medicalization’ where the profit motive plays a significant role in transforming non-medical problems into medical ones. The psychiatrist David Healy has provocatively dubbed this as the ‘marketing of disease.’
In a culture where medicine has become big business, patients qua consumers go to physicians with self-diagnosed disorders or with symptoms of ‘contested illnesses’ like fibromyalgia or chronic fatigue syndrome that they gleaned from the Internet requesting for treatment. In this regard, the Internet has also played a huge role in the medicalization of society.
Needless to say, over-medicalization is detrimental to the health of society. It has transformed normal human differences into pathologies – diagnosable disorders that require medical intervention. Breast size, shortness and male baldness are subtly pathologized by society and seen as treatable ‘medical’ conditions.
‘Where bodies were once understood normatively healthy and only sometimes ill,’ write Geoffrey Poitras and Lindsay Meredith perceptively, ‘effective marketing has individuals seeing their bodies as inherently ill, and only able to be brought to health with effective medical treatment.’
Medicalization has also changed our definition of normality. ‘Medical designations’, observes Peter Conrad, ‘are increasingly defining what is “normal”, expected, and acceptable in life.’
As we have seen, shyness is one example. Another example is the way in which expectations of the sexual performance of older men have changed with the introduction of Viagra and the medicalization of erectile dysfunction (ED). As physician Steven Levine points out: ‘We used to treat older people as though sex was not possible; and now we’ve flip-flopped and transmitted the message that everyone is supposed to have fantastic sex forever.’
As medical jurisdiction expands, medical social control will also correspondingly widen. Medical norms that determine the way we understand our bodies, behaviours and health must be subjected to rigorous theological and ethical evaluation and critique. And where they violate human dignity or promote discrimination and injustice, they must be roundly challenged.
Dr Roland Chia is Chew Hock Hin Professor of Christian Doctrine at Trinity Theological College and Theological and Research Advisor of the Ethos Institute for Public Christianity.