The Medicalization of Society: On the Transformation of Human Conditions into Treatable Disorders

Written by Peter Conrad Reviewed By S. Elizabeth Whitmore

Peter Conrad’s interest in the sociological aspect of disease began in the 1970’s with his study of childhood hyperactivity. He returned to his study of the medicalization of disease in the 1990’s as he observed the increasing number of conditions that had been labeled medical illnesses. His goal in writing this book is not to judge the appropriateness of these new diagnoses as medical illnesses nor catalog all newly medicalized diagnoses, but instead to select several new diagnoses, examine their evolution, and reflect on them from a sociological perspective. He appears to have been successful in his pursuit. Conrad begins by explaining that he desires to explore “illnesses or ‘syndromes’ that relate to behavior, a psychic state, or a bodily condition that now has (have) a medical diagnosis and medical treatment” (p. 3). And although not seeking to judge the appropriateness of these new diagnoses, he states, “What constitutes a real medical problem may be largely in the eyes of the beholder or in the realm of those who have the authority to define the validity of the diagnosis that is the grist for the sociologic mill” (p. 4).

As an introduction to familiarize the reader with the newly identified medical illnesses, he enumerates those now recognized in the early 21st century, only having been labeled as such over the last 30 years. These include attention-deficit/hyperactivity disorder (ADHD), anorexia, chronic fatigue syndrome (CFS), post-traumatic stress disorder (PTSD), panic disorder, fetal alcohol syndrome, premenstrual syndrome (PMS), obesity, alcoholism and innumerable addictions, Gulf War syndrome, and multiple chemical sensitivity disorder. Additionally, disorders or deficiencies seemingly recognized with the development of “medical solutions” include menopause, andropause, erectile dysfunction, baldness, adult ADHD, generalized anxiety disorder (GAD), social anxiety disorder (SAD) or “social phobia”, and childhood short stature. With some diseases, diagnostic criteria have changed giving the appearance of a sudden epidemic of new disease. The most striking example of this is Alzheimer’s disease in which removal of the age criterion led to the labeling of senile dementia as Alzheimer’s disease, making what previously was a rare disease exceedingly common in the aged.

Another interesting change promoted by pharmaceutical companies and professional societies is the association and medicalization of risk factors, as has been seen with hypertension and hypercholesterolemia. Consumers and doctors are led to believe that a risk factor for a disease is itself a “disease.” In their advertising, pharmaceutical companies suggest prehypertension should be treated but will not reveal the number of individuals with prehypertension one would need to treat for 20 years in order to prevent one individual patient from having a heart attack or stroke (i.e., number needed to treat), nor will they reveal the associated costs of the drug, physician visits for monitoring, and side-effects over 20 years. Finally, although rare, occasionally the demedicalization of a disease occurs. The notable example of this is homosexuality, which was considered a psychiatric disorder (classified under “Personality Disorders and Certain Other Non-Psychotic Disorders”) in the Diagnostic and Statistical Manual of Mental Disorders II (DSM-II; American Psychiatric Association, 1968) until a reversal in 1974.

As one might guess, the driving forces behind medicalization of disease vary from disorder to disorder. The obvious facilitators include physicians, patients, advocacy and special interest groups, professional societies, and pharmaceutical companies. The latter group has gained greater influence with the introduction of direct-to-consumer advertising. An individual’s medical insurer is the final agent determining whether payment is valid for treatment of a diagnosis. For example, insurance companies do not cover Propecia (finasteride) for treatment of male pattern baldness while most cover a limited number of Viagra (silfenadil) tablets per month for erectile dysfunction, even in the absence of an identified cause of impotence.

We have already seen how Conrad does not attempt to judge the validity of these new diagnoses as true medical diseases. My own impression after reading this book, as both a physician and a Christian, is that much is at stake in this discussion, especially from the concerns of Christian anthropology and psychology. Unspoken assumptions about human identity, behavior, and sin, are bound up in complex ways with many of these diagnostic developments. I cannot unravel all the issues here, but I am convinced that it is incumbent upon each of us in the body of Christ to examine this medicalization of disease carefully from a biblical wisdom perspective before accepting many of these new diagnoses as bona fide diseases. We are on difficult medical/theological terrain here, yet one can argue that many of these conditions result from rebellious separation from God or possibly represent circumstances, providentially given by God, to draw us to depend more on Him (of course these theological categories must be handled with care!). Also, in those instances when diagnoses are judged valid, it would seem wise to consider the possibility of using medications as a “bridge” for a defined period of healing or normalization instead of accepting them as lifelong therapy.

In sum, the issues raised by this monograph are important, complex, and increasingly relevant for all of us who live in the modern world. For readers interested in finding thoughtful resources to engage these matters further, the President’s Council on Bioethics has examined many of these issues in great depth. The most relevant volume here is Beyond Therapy: Biotechnology and the Pursuit of Happiness (2003), available for free online at www.bioethics.gov. Readers should also be aware of the helpful resources offered by the Christian Medical and Dental Association (cmda.org) and the Center for Bioethics Human Dignity (cbhd.org).


S. Elizabeth Whitmore

Johns Hopkins University School of Medicine

Baltimore, Maryland, USA

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