Wednesday, March 24, 2010

When Life Becomes "Medicalized"

On March 22, I encountered a really interesting interview in the Boston Globe's G Magazine with Brandeis Sociology professor Peter Conrad, entitled, "What is a 'disease?'

G magazine staff member, Karen Weintraub writes:

"Are you over 50? You must need your cholesterol lowered. Is Johnny having trouble at school? Don't ask about the quality of teaching, put him on medication.....Peter Conrad first looked at this 'medicalization' and its implications for health and society in the 1970's and early 1980's, and saw doctors and groups like Alcoholics Anonymous redefining social problems such as alcoholism and normal events such as childbirth into medical problems. When he examined medicalization more recently, he realized that the drivers had shift to drug and insurance companies and to the patients themselves."

I found myself reflecting on the question of whether medicalization was good, bad or indifferent....and why so many basic human experiences--some problematic and some not--were being defined in medicalized terms.

For example, childbirth is a natural part of the cycle of life. I have watched my cats give birth to kittens both when I was a child and two years ago with our male and female Siamese cats. Prayer, our chocolate point Siamese, managed to make her way through a normal pregnancy without any doctor's appointments, medical tests or monitoring, and through the magic of nature, intuitively knew how to give birth to her kittens, care for them at the time of birth, and encourage them to nurse and stay close in their early hours, so they could begin to thrive.

One of her kittens was born with a birth defect, and started to fail to thrive. I called the vet to ask for help, and she informed me that there was no way to help a two day old kitten other than to try to get the kitten to latch on and nurse or place a drop of water on the kitten's mouth to see if it would take the water in. I tried both of these coaching tips, but the kitten failed to thrive and died. Perhaps this was nature's way of ending a life early when there was a deeper condition underlying the failure to thrive.

Had I not had a complication with this one kitten, Prayer and her young ones would not have needed medical consultation until it was time for the kitten's first shots many weeks later. Prayer's pregnancy and birth did not need to be "medicalized." They could be understood in the continuum of life as a natural, healthy and feline (though also human) experience.

The line between medical support and medicalization is an interesting one. Many human women do have more complications during conception (such as infertility issues), pregnancy and birth. And because both a mother's and baby's lives are at risk, medical monitoring is indeed a safety measure for both mother and child. However, many of the natural instincts that Prayer demonstrated are also available to humans, if only they trust their bodies and the wiring that has been part of them for millennia.

But because we have been raised in a culture of medicalization, we tend to place our trust and our power to the medical establishment and NOT to our internal and intuitive wisdom.

Sadly, many natural experiences--parts of the human continuum of life--have been turned into diseases, rather than seen as natural evolutionary processes. In the article, Conrad notes that menopause is one of them.

All women who live into their 50's (and on rare occasions, 60's), will experience menopause. It is part of the fabric of life, just is menarche. For some women, the perimenopausal passage (the 10 year window from the start of pre-menopause to the cessation of menstrual periods, which is technically, what menopause means) is uneventful and nothing really changes significantly emotionally, physically or relationally. For other women, this passage is difficult and medical issues can arise. However, menopause itself is NOT a disease, but a natural biological process.

Today, the pharmaceutical industry drives medicalization because it is profitable to do so. If you create a drug, you need a market. Peter Kramer wrote, Listening to Prozac, exploring whether people who were not depressed but just wanted to be more extroverted or outgoing, might electively choose to take Prozac, because one of the benefits people reported from using the drug was this kind of personality change. In a world that rewards extroversion and go-getting, and pulls away from introversion and those who are judged "too sensitive," if a little pill can give you a personality makeover, it may give a boost to your career!

Conrad notes that Viagra is another example of how the pharmaceutical industry has pushed medicalization to sell drugs. "Viagra was introduced in (1998) as a drug that could help people with prostate problems and diabetes and other physical problems." But in a culture where eternal virility is as desireable as a fountain of youth, other populations became lucrative targets for the drug. So, old people, and athletes became spokespeople, and suddenly Viagra ad became not only grandpa's little helper, but also "everyman's" magic pill, the star of professional football games' tv ads.

Sometimes people want their conditions medicalized, because they face challenges in their lives and need help coping with society's demands. Conrad notes adult ADHD is a consumer-driven medicalization phenomenon.

When people struggle, they turn to the medical industry for help, not one another. There is no social or community catchment net. Everyone is too busy to bother with their neighbor's struggles. And who feels qualify to understand, never mind help, the complex experiences we suffer from in daily life?

Once upon a time some of the traits of ADHD might have been considered "hunter and gatherer" traits. In a primitive society, the very traits that make it impossible to sit at a desk for 8 - 12 hours, allowed people to do what needed to be done to survive. Is this really a disease or a mirror of how hard it is to adapt our neurology and physiology to a world of rapid change, and customs far different from ones our biological ancestors lived with for centuries if not millennia?

In this sense, medicalization compromises or even loses sight of our basic humanity. And Conrad points out, what to me is perhaps the saddest application of medicalization, it's use as a form of social control. He gives the example of the increasingly common use of psychotropic drugs in nursing homes. Many patients receive these medications not because they are actually psychotic, but because the medications make them easier to "handle."

When "medicalizing" creates tools for care and empowerment, it can be a good thing. But sadly, when money, power and politics are driving forces, "medicalization" can become a form of "dehumanization."

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