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."

A Revised Definition of Insanity

Many years ago, I was told that the definition of "insanity" was doing the same thing over and over again and expecting a different result. For many years, that seemed to make good enough sense, and I could see plenty of real world situations where that definition applied.

In today's world, as our infrastructures break down, I think it is time to redefine what "insanity" is. Now, "insanity" is trying to reconcile a seemingly simple problem using the rational, clear and definited channels made available to you, and expecting to actually reach a resolution.

Here's just one example. My parents are in their 80's. My father is dying of colon cancer and my mother is taking care of him. Many decades ago, my father purchased bearer bonds from the US Government, which have coupons that can be redeemed twice a year, paying interest on the bonds. The interest from the bonds has helped pay for my parents' living expenses since my father retired from his job. And my mother would go into Boston to a bank that could redeem the coupons.

Today, bearer bonds are no longer issued. And many people have never heard of them. However, this is only backstory.

On Saturday, I received a notice from the local bank my parents use with a "bounced check" from the Boston bank who redeem the bond coupons for my mother. I was surprised to see a "bounced check" since I would expect there to be funds in a big bank's account to pay a small coupon redemption fee. The reason for the bounce listed was "refer to maker." I had no clue what this meant.

I had to wait until Monday to call my parent's local bank to inquire what this meant and what to do to get my parents their money. The local bank had no clue what "refer to maker" meant and said I had to call the Boston bank to find out.

I called the Boston bank, and they told me they could not help me, because the check was issued by their corporate office in Minnesota. I called the corporate office in Minnesota, and got a very nice man named Greg, who truly wanted to help reconcile the problem. He did research on why the check might have bounced and could not come up with a reason. There was money in their account. There had been no stop payment issued on the check. He said I needed to speak with the local bank again, and that they could call him to discuss the problem.

I called the local bank again, and spent 45 minutes on successive holds, as the issue was escalated up the customer service center supervisory chain. No one there had the authority to speak with Greg at the other bank. I was told I had to walk into a local office of the local bank and someone there could call Greg and solve the problem.

I went into the local branch of the local bank and met with the branch manager to solve the problem. I spent 40 minutes with her as she escalated the issue through her support chain, and was told they could not figure out the problem and no one had the authority to call Greg. She told me I had to physically bring in the facsimile of the returned check to the originator and get it reissued. I explained it came from Minnesota, and I was NOT going to hand carry the facsimile to Minnesota.

She said I could not redeposit the facsimile because the processing people had made a technical error on the original check and had double printed a set of numbers, so the facsimile would be rejected. I asked her to remove the $10 service fee issued to my parents' account, since they should not have to pay for an error that had nothing to do with them or even the Minnesota bank. I was told this was not possible. There was no procedure to do this.

I pushed back and said this was not fair. Why should 80 somethings have to pay a fee for something that had nothing to do with their actions. She said she would file a claim to try to get the fee removed, but the process was cumbersome and unlikely to bring a positive outcome.

Now, having invested 3 hours of my day trying to solve the problem, in addition to working with clients and checking in with Alex, my son, after school, I called the Boston office of the check issuing bank and told them the dilemma. They reaffirmed they could not do anything and I needed to talk to Greg in Minnesota again.

I reached Greg, and he said this was insane. He said the banking industry is totally dysfunctional, because people are not in jobs long enough to know what is going on or how to solve problems. They receive no training, and get frustrated and turn over, and leave customers in the lurch with serious issues that are not able to be reconciled.

I asked Greg how long he had been in his job, and he said 10 years. He said that was unusual. He said his bank required people who were going to handle customer calls like mine to have 6 weeks of traning before they answered one customer phone call.

Greg instructed me that I could mail in the bounce slip and the facsimile check, but that I had to write a letter and get my mother's signature and state the the local bank had a processing error and we needed to get the check reissued. There were certain conditions that would require a notary to sign and seal her signature and mine. But we were able to define a set of circumstances that would allow me to just bring the letter to my mother and have her sign it and have me send off the paperwork and hope for the best.

Now, 4 1/2 hours of my day into trying to solve this problem on behalf of my parents, I still don't have it solved. And I cannot imagine my 82 year old mother who is trying to care for my 84 year old father who is in the last stages of dying from colon cancer having to go through what I went through today to reconcile a seemingly simple problem.

In fact, I can't imagine my mother even understanding my attempt to explain what happened, what it means and what we need to do to solve the problem. Should an 80 something be subject to this kind of wild goose chase when tending to a dying spouse? Should ANYONE be subject to this kind of wild goose chase?

And how many people would have the tenacity and wherewithall to keep pushing for resolution when one pathway leads to another dead end and it all comes back in a circle to where you started?

How many stories are there like this of people trying to reconcile issues that impact their daily survival--be it with banks, insurance companies, hospitals and other social institutions? And how did we get here?

Somehow, we need to gather together from the bottom up and rebuild models of commerce so that transactions are more grounded, and the complexities of overcompartmentalization and reliance on technology to the point that humans are unable to solve seemingly simple problems can be eliminated.

On the upside, it is much harder to do the same thing over and over again, at all, never mind expect different results. Following a pathway is likely to lead to a random, chaotic or circular trajectory that could probably not be repeated, because different characters will pick up the phone or e-mail as jobs turn over or are handled by multiple people, all sharing the same function.

I will see this through til my parents get their check reissued and successfully deposited into their checking account. But how many more times will this kind of craziness or worse knock at the door?

Perhaps another definition of insanity is "the resulting condition of trying to solve a human scale problem in a chaotic, dysfunctional world."

©2010 Linda Marks