Peter Conrad's Medicalization of Society was a truly enlightening read that clarifies a lot of questions on the origins of certain "diseases" prevalent in our society today which were virtually unheard of a few years ago. We touched upon the phenomenon of social constructivism in class today--the concept that social interactions breed awareness and shared cultures and values within microcosmic groups. This idea certainly seems to apply to Conrad's book, especially as he delves into the more recently publicized gender-specific "diseases."
It seems that the medical and pharmaceutical industries have taken on heavily capitalistic undertones, almost mimicking the economic system and values of the United States by providing "consumers" (formerly known as patients) with goods (medications.) Furthermore, many of these drugs, especially the most lucrative on the market, are provided to abate socially constructed "diseases" which undermine culturally defined norms of behavior and gender stereotypes. This concept definitely aligns itself with the social constructivist phenomenon in conceding that most societal values are not innately human but constructed and reflections of a specific culture. This idea is further justified in how familiar/common discussion has become surrounding these "diseases" which once went "untreated" because of their taboo like qualities (i.e- erectile dysfunction, PMS.) Nowadays, discussing menstruation, selling erection pills or advertising for the new and improved bionic penis surgery is common, strewn throughout newspapers, even. It seems as if modern medicalization conveys how society has evolved from one embracing privacy to a more liberal forum. After all, just a few decades ago seeking out and discussing the need for psychological/psychiatric help was unheard of and now it seems everyone has a shrink.
Throughout Conrad's book I found myself continuously asking the same questions. Does modern, evolving medicalization create a better quality of life for our society by utilizing capitalistic rituals within the healthcare system? Or does modern medicalization stigmatize natural occurrences which once went undiscussed for a reason? Is our medical system creating more insecurities for an already vulnerable society?
Monday, March 19, 2012
Talk to Your Doctor
I found the reading very interesting as it provided a solid background and answered some previous questions of mine. For example, I’ve always been interested in the fact that many drugs are able to be advertised to patients, or consumers, I’m torn between which is the proper term. So, it was useful to read about the increase in the ability for pharmaceutical companies to advertise directly to consumers as opposed to just physicians not only in magazines but also in television commercials. I was surprised to read that $4.5 billion was spent advertising medications in 2005 (Conrad, 17). I was even more surprised to read about how effective that advertising is on consumers with every $1 spent on advertising translating into $4.20 spent on pharmaceutical drugs (http://prescriptiondrugs.procon.org/sourcefiles/Impact-of-Direct-to-Consumer-Advertising-on-Prescription-Drug-Spending-Summary-of-Findings.pdf )** That’s a pretty amazing return and explains why pharmaceutical companies do spend so much on advertising their drugs. But it raises the question of whether it’s ethical. Should they be able to leverage so much influence on patients? Do you think that patients should be able to ask their doctors to try particular medications or should doctors recommend the medications? I’m personally slightly ambivalent in regards to this question. I think patients should have the ability to do research and make a decision about which prescription is right for them without being entirely influenced by the doctor, but I’m also wary about the influence that advertising or social groups might have on the individual’s decision. I I question how much of a role they should have in advertising, if any. There are certainly some perverse incentives for them to market certain illnesses as if to convince consumers they are suffering from the symptoms described in the commercial or magazine ad and that they should do something to get treated. I’m certainly looking forward to our next reading assignment on drug companies.
**note: I’m pretty sure this same statistic was mentioned in the reading too, but I couldn’t find it.
Thoughts on Medicalization of Society
While reading Peter Conrad’s book Medicalization of Society, there are
many aspects of medicalization that I find very interesting. As someone who one
day hopes to be a doctor, I find myself trying to justify the benefits of
medicalization. But at the same time, having mother that often prefers the
ideas of more Eastern medicine and believes that America is over medicalized
leaves me a bit skeptical. My skepticism, however, does not stem from the
disbelief in the effectiveness of more Western medicine but more in the
distrust of the corporate giants of the biotechnology and pharmaceutical
companies.
I tell
myself that having huge companies is the most efficient way to develop and
produce many of the technological and pharmaceutical advances in medicine. But
keeping in mind that the main goal of these companies is often to make a
profit, failure does not seem to be an option for the huge investments they
make. As Conrad quotes from Goode in the Medicalization
of Society, “‘The impression often conveyed by commercials for the drugs is
clear: almost anyone could benefit from them’” (19). Conrad also says how the
companies seem to advocate the “problem” their drug “cures” as both common, to
eliminate the stigma, and abnormal, as to justify medical interventions. This
deception is what often leaves me skeptical. As a doctor one day, I hope to always
keep the patient care as my top priority by having a healthy level of skepticism
while not letting the skepticism interfere with the benefits of medicalization
and potential medical advances. Doctors need to look at patients as patients,
not consumers.
Medicalization
I found this text stimulating, mainly because as Emily stated, we are living in the middle of "Medicalization," which is defining many oft-described conditions as new pathologies, in need of medical care.
I always seem to find myself on the fence about many of these conditions, such as ADD and ADHD. As Professor Jennings mentioned today, many feel that we are simply medicating people instead of working to provide an environment conducive to growth. I agree with that anti-medicalization stance, but I also recognize that many of these "new" conditions which have come about do in fact have symptoms which can be helped through medicine. As a result, I think the classic drop in expectations of the "diseased" must be changed along with the amorphous category. Many of these conditions in contention, such as ADD/ADHD should not only be treated with only drugs or only without drugs (most people seem to be on one side or the other), but should be treated with both lifestyle changes, as well as drug intervention if needed.
I find it extremely difficult to take sides on any of these diseases or conditions, because I see the point of view that a pathology causes most of the conditions, as well as idea that medical intervention is not needed for most of them. I feel that this is where the thin line between "necessary treatment" and "quality treatment" lies. Of course one does not need Ritalin to survive, but treatment for ADHD could improve a person's life considerably. Essentially Conrad's book once again reinforced the idea that the relationship between society and healthcare is extremely complicated, and changes as society does.
I always seem to find myself on the fence about many of these conditions, such as ADD and ADHD. As Professor Jennings mentioned today, many feel that we are simply medicating people instead of working to provide an environment conducive to growth. I agree with that anti-medicalization stance, but I also recognize that many of these "new" conditions which have come about do in fact have symptoms which can be helped through medicine. As a result, I think the classic drop in expectations of the "diseased" must be changed along with the amorphous category. Many of these conditions in contention, such as ADD/ADHD should not only be treated with only drugs or only without drugs (most people seem to be on one side or the other), but should be treated with both lifestyle changes, as well as drug intervention if needed.
I find it extremely difficult to take sides on any of these diseases or conditions, because I see the point of view that a pathology causes most of the conditions, as well as idea that medical intervention is not needed for most of them. I feel that this is where the thin line between "necessary treatment" and "quality treatment" lies. Of course one does not need Ritalin to survive, but treatment for ADHD could improve a person's life considerably. Essentially Conrad's book once again reinforced the idea that the relationship between society and healthcare is extremely complicated, and changes as society does.
Expansion of Medicalization and Normalcy
In his book The Medicaliztion of Society, Peter Conrad defines medicalization
as the “process by which nonmedical problems become defined and treated as
medical problems, usually in terms of illness and disorders,” using medical
terminology, medical framework, and medical treatment interventions (4). Over
the last decade, due to not only physicians, but also individuals, social
groups, and pharmaceutical companies, there has been a trend towards
medicalization and medical jurisdiction leading to an increasing “number of
life problems,” everyday life events, and “problems that previously were not
deemed to fall within the medical sphere” now being defined as “medical” (3,4).
Thus, medicalization encompasses deviance from and across a broad range of
normal life activities.
Conrad touches on a number of
positive consequences as a result of medicalization. These include reduction of
stigma, allowance of individuals to function better in society, acceptance of
various social groups, access to accommodations, extension of the sick role,
legitimization of individuals’ concerns and ailments, increasing awareness of
social pressures, and increasing insurance coverage.
At the same time, I believe Conrad notes
one major problem with medicalization: the fact that it “transforms many human
differences [and aspects of everyday life] into pathologies” (148). These include differences in aging,
learning style, sexual desire, stature, and shyness. In this respect,
medicalization narrows “the range of what is considered acceptable” and normal
and “diminishes our tolerance for and appreciation of the diversity of life” (7,
148). Additionally, over the course of time, the standards for what are
considered “abnormal” (ex. high blood pressure, obesity, diabetes, etc) are
continuously being changed and lowered. Thus, together, more and more people
have been categorized as being unhealthy and “abnormal.” Since this has been
the trend in the past, it seems that it will continue to be the trend in the
future. Thus, medicalization, in a sense, seems to be a never-ending process
where only more and more people are going to be categorized as unhealthy and
“abnormal.” This warrants the question: what is/will truly be considered
normal, expected, and acceptable in life and our society? What differences
truly warrant/will warrant treatment? Eventually, all of them?
As Conrad notes, in our society,
health is a high value-asset. In an essay titled “What’s Making Us Sick Is an Epidemic of
Diagnoses” in the New York Times, H.
Gilbert Welch, Lisa Schwartz, and Steven Woloshin make us consider that many of
us are told that we are sick only because of the growing number of “medical
diagnoses” existing as a result of medicalization. However, they state that “doctors need to
remember the value of reassuring people that they are not sick,” thereby once
again valuing health itself. They
make a very interesting suggestion that “someone should start monitoring a new
health metric: the proportion of the population not requiring medical care.”
Perhaps looking at such a metric will help us re-value health as a society as
well as help us reconsider the expansion of medicalization and the concept of normalcy.
Adult ADHD = Unhealthy habits?
During one summer, I taught at an after-school program and one of the students was diagnosed with ADHD. Teaching him in a classroom setting was very difficult especially since I never taught children with this kind of disorder. Also, his symptoms were distracting to the other students. It was very much of a shock to me that adults can also be diagnosed with the disorder because when it comes to ADHD in children, focus is on their "behavior". And so, you do not suspect this kind of behavior from adults which is why "performance" becomes the focus. I very much agree that ADHD in adults can be a "medical excuse" that ultimately reduces self blame for the symptoms. Some of the common symptoms mentioned online are: sense of underachievement, doesn’t deal well with frustration, easily flustered and stressed out, trouble staying motivated, tendency to take risk, getting bored easily, and etc. Looking at these symptoms, I feel like majority of people in general would have these symptoms. One of the symptoms that caught my attention was hyperfocus, where you are concentrated in one activity that you don't even know that time is passing by. Reading this, I just thought this was just another excuse for someone to be diagnosed easily.
I feel as if any of the symptoms can be personal insecurities that one can go through which is normal. It is no wonder that many adults self-diagnose themselves so easily because the symptoms are weaknesses people do not want to reveal to others. Living in a society where titles, degrees earned, and credentials are everything, we do not like to reveal signs of weaknesses. Also, as adults we have the capability to hide these symptoms and suppress them unlike children where we can clearly see their symptoms. Therefore, self-diagnosing yourself with ADHD can be a cover-up of one's unhealthy habits. Instead of trying to resolve the root of each problem, I feel that being diagnosed with ADHD is definitely an easy way out. I consider it to be an easy way out because through medication one can obtain faster results and people can continue on living with their bad habits. Overall, this is just my first reaction to this disorder. I hope to be able to understand this disorder better because I'm very unsure where the boundaries are when it comes to being diagnosed with ADHD.
I feel as if any of the symptoms can be personal insecurities that one can go through which is normal. It is no wonder that many adults self-diagnose themselves so easily because the symptoms are weaknesses people do not want to reveal to others. Living in a society where titles, degrees earned, and credentials are everything, we do not like to reveal signs of weaknesses. Also, as adults we have the capability to hide these symptoms and suppress them unlike children where we can clearly see their symptoms. Therefore, self-diagnosing yourself with ADHD can be a cover-up of one's unhealthy habits. Instead of trying to resolve the root of each problem, I feel that being diagnosed with ADHD is definitely an easy way out. I consider it to be an easy way out because through medication one can obtain faster results and people can continue on living with their bad habits. Overall, this is just my first reaction to this disorder. I hope to be able to understand this disorder better because I'm very unsure where the boundaries are when it comes to being diagnosed with ADHD.
Thoughts on the Medicalization of Society
In The Medicalization of Society, James Conrad explores a societal shift which I have noticed in my lifetime, but never really knew how to define. According to Conrad, the concept of medicalization is defined as "a process by which nonmedical problems become defined and treated as medical problems, usually in terms of illness and disorders". For example, disorders such as depression or ADHD were not traditionally considered diseases, but are now being treated medically. I will say that I have always been critical of this movement. However, after reading Conrad's dissection of the topic in his book, I am a bit conflicted about my opinion.
Perhaps it's because I was raised with the "deal with it" school of thought, but I've always considered the shift towards medicalization a bit spoiled. As a child, I was taught to think of medicine as a last resort or "easy way out" for dealing with colds, mild fevers, etc. Instead food, rest, and other remedies targetted towards overall health were preferred. (One of my friends almost never gets sick and attributes his resilience to the fact that he was never allowed to take cold medicine as a child.)
It's not that I'm against the idea of medicine, I just feel like idea of labeling an ailment as a "disease" instantly frees the person from responsibility. For example, I have been tempted to say that I was "depressed" before, but in reality all I needed to do was go outside and blow off some steam or find a new hobby. I am sensitive to the fact that chronic depression is a very real and serious concern for some, but that's not what I'm talking about. What scares me is how easy it is to dismiss discomfort as "disease".
In the first chapter of Conrad's book, he discusses the evolving roles of physicians and medical authority. He cites the the widespread influence of physicians as a driving force behind medicalization. He states thats that his relationship is evident in the medicalization of "hyperactivity, menopause, child abuse, and childbirth, among others." This point made me redefine my idea of medical intervention. Maybe medical treatment does not always relieve the patient from responsibilty, but sometimes actually helps them realize that they are ultimately responsible for their own health. (I think this is true in the case of obesity and drug related disorders.) Perhaps the modern physician's role in society is not to treat problems traditionally thought of as disease, but rather to provide support for a wide range of discomforts.
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