The concept of medicalisation reassessed

A Rejoinder

Datos Bibliográficos

ID2249289
AutoresJoan Busfield (0000-0002-9377-1909, Department of Sociology University of Essex UK, autor de correspondencia)
Año2017
Volumen39
Número5
Páginas781-783
Fecha de publicación2017-06-01
Peer ReviewedSí
Open AccessSí
TipoARTICLE
RevistaSociology of Health & Illness (JOURNAL)
Identificadores de la revistaISSN: 0141-9889 • E-ISSN: 1467-9566
EditorialWiley (PUBLISHER • GB)
DOI10.1111/1467-9566.12587
PMID28627720
OpenAlexW2635354783
IdiomaEN
Citas recibidas4
Referencias citadas5

I appreciate Simon J. Williams, Catherine Coveney and Jonathan Gabe (2017), taking the time and effort to respond to my paper ‘The concept of medicalisation reassessed’ (Busfield 2017), and am grateful for the series of positive comments they make about it. However, the authors go on to argue that the paper ‘rests on a somewhat partial and problematic engagement with and reading of these matters’ (p. 1), identifying four areas of concern: ‘(i) conceptual coverage; (ii) conflationary charges; (iii) new concepts, and; (iv) developing directions’ (p. 1). These criticisms raise some important issues and call for a response. On the issue of conceptual coverage, the authors argue that I fail ‘to fully articulate or elaborate upon the different dimensions and directions of medicalisation’ (p. 2). Certainly I do not highlight these issues, though I do mention demedicalisation, albeit only once (probably because it is less common), but discussion of the full range of dimensions and directions was not the purpose of the paper, and space constraints would have prohibited it. Rather surprisingly, as if in support of this charge, the authors then cite Peter Conrad's view that medical categories are ‘elastic’, and that ‘medicalisation research does not adjudicate whether or not an entity is ‘really’ a medical problem, but rather how it became [sic] to be depicted (and accepted) as a medical problem and with what consequences’ (2015: vii). The implication is that I do not recognise these points, yet, on any reading of my paper it is surely plain that, in my analysis of the concept, I am entirely in agreement with Conrad on these matters. On the second point of my ‘conflationary charges’, which refers to the tendency of some authors to conflate medicalisation and medical imperialism, the authors of the Rejoinder argue that ‘these dangers have long since been aired if not laid to rest in the history of medical sociology itself’ (p. 2). However, as I make clear in the introduction to the paper, one of my explicit objectives was to provide an archaeology of the concept in which some reference to the conflation by writers such as Phil Strong (1979) in his reading of Ivan Illich's work, and picked up by Simon Williams (2001) himself, is necessarily a part, even though both are critical of the thesis of medical imperialism – something I could perhaps have emphasised. Further, my reassessment uses Ballard and Elston's (2005) critique of the concept of medicalisation as a framework for analysing criticisms of the concept, and these authors identified an over-emphasis on medicine's imperialistic tendencies, encouraged, I suggest, by the conflation, as one of the problems with it. Hence the conflation could not be ignored and has contributed to the hostility of some to the concept. Consequently, while I am inclined to agree with the authors that most sociologists in the field do not now see medical imperialism as the key factor generating medicalisation, the conflation did occur in some earlier work and should not be written out of its history. Moreover, though most sociologists now accept that the concept of medicalisation should be used descriptively, and does not provide an explanation of the expansion of medicine's domain, I do not consider that the charges of conflation ‘have long since been laid to rest’, since unfortunately the term itself can rather readily be taken to suggest that the medical profession plays a key part in contributing to the process of medicalisation. The fact that Strong imaginatively turned the charge of imperialism onto sociologists themselves is not, in my view, relevant to the issue. Third, there is the charge that the paper neglects new concepts, in particular Moynihan et al.'s (2002) concept of disease mongering. Transforming this particular absence into a general charge of neglecting new concepts is somewhat strange, since the paper is a defence of the value of the concept of medicalisation over the newer concepts of biomedicalisation and pharmaceuticalisation. However, the key reason for the absence was that I do not regard this concept as sufficiently important or illuminating, or of much value to sociologists. Although Moynihan et al.'s discussion of the construction of particular disease categories is not uninteresting, and the concept has some utility in certain contexts (I have used it occasionally), and has, as the Rejoinder authors contend, ‘gained some traction’ (p. 3) within medical journals, this is not enough to give it significant analytical value for sociologists. Fourth and finally, there is the matter of ‘developing directions’. Here the charge is that I largely write off the value of the concept of pharmaceuticalisation. The authors recognise that I have a particular interest in pharmaceuticals and the pharmaceutical industry and seem surprised that I do not consider pharmaceuticalisation an ‘adequate alternative’ to medicalisation, while themselves regarding it as ‘a complementary or related conceptual tool’ (p. 3) – a position that seems rather similar to the one I adopted in the paper. In their defence of the latter concept, they argue in particular that ‘not all cases of pharmaceuticalisation involve medicalisation’ and proceed to give some examples, one being the pharmaceutical enhancement of the healthy. Here they rely on Conrad's definition of medicalisation as ‘the process by which nonmedical problems become defined and treated as medical problems’, emphasising the final clause of this sentence ‘usually as diseases or disorders’ (2015: vii). However, one could note here Conrad's careful addition of the word ‘usually’ that readily allows the use of bodily enhancement drugs to count as an instance of medicalisation. They also rather imply that departing from an emphasis on defining problems as diseases or disorders when deploying the concept is not acceptable. Certainly my use of the term medicalisation differs somewhat from Conrad's focus on defining and treating non-medical problems as diseases or disorders, instead using the term to refer to the extension of medicine's domain without necessarily requiring the problem in question to have to be defined as a disease or disorder, though recognising that often it will be. I considered whether I should draw attention to my use of the concept in the paper and the way it departed a little from Conrad's, but decided that this would require a lengthy digression. Yet, interpreted in the way that I do, the concept of medicalisation readily covers the use of medical interventions of all types, including pharmaceuticals for the purposes of bodily enhancement. It is true that the term pharmaceuticalisation can be used to examine shifts between different types of treatment, like the move away from medicines to treat sleep problems towards cognitive behaviour therapy that the authors mention, which is an important change. But sleep problems have already been largely medicalised in that they are frequently brought to medical attention and defined as insomnia, and it is debatable how much value is added by using the term pharmaceuticalisation (or indeed in other cases de-pharmaceuticalisation) to examine the change in treatments. The same applies to the ‘domestic use of pharmaceuticals for aesthetic reasons’ (p. 5) to which the authors refer, arguing that in such instances ‘pharmaceutical use becomes detached from the therapeutic context and discourse of medicine and health’ (p. 5). However, as I pointed out in the paper, this use still depends on the medical profession's imprimatur of the relevant drugs as having value for this purpose. And, as I also noted, pharmaceuticals are after all routinely termed medicines. To say this is not to deny the growing importance of medicines and the pharmaceutical industry, and the use of the term pharmaceuticalisation does direct attention to the industry's activities, as well as to the specific role of medicines, but these can be examined very thoroughly without using an additional, and in my view rather cumbersome, concept. My conclusion is therefore, that while the term pharmaceuticalisation may be useful in certain contexts, the concept of medicalisation is very often more pertinent and illuminating

Epistemology · Psychoanalysis · Sociology · Body Image and Dysmorphia Studies · Mental Health and Psychiatry · Pharmaceutical industry and healthcare · Philosophy · Psychology