I appreciated the "bracketing whether a phenomenon is "really" a medical problem" (10) point that Conrad made. He mentions it various times throughout the book. The first time he says:
We can examine the medicalization of human problems and bracket the question of whether they are "real" medical problems. 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 a problem as medical (3-4).
Often, when I have been exposed to the medicalization discussion/debate it often veers towards inadvertently undiagnosing people. Essentially stating that certain diagnoses are not real or over-diagnosed and therefore (at least most of) the people receiving that diagnosis don’t really have anything wrong with them. This has always been very problematic to me and I’ll come back to that point later. Also, he makes the important point that “Having a biological basis does not make something ipso facto a medical problem." (146). Often when research points to a biological cause for a phenomenon we immediately label it as a medical problem based on that evidence.
I also wanted to touch upon the effect of health insurance on medicalization. I felt that this point was eventually made towards the end of the book but seemed to be downplayed throughout. He explains that, "the fact that insurance companies won't pay for treatment of certain medical diagnoses limits its medicalization but does not necessarily undermine it, so long as medical categories are accepted and applied to problems" (11). He also mentions the bizarre situation caused by the fact that psychotherapy is not usually covered but psychiatric medications are. This places the focus more squarely on medicalization, since psychiatric drugs must be prescribed by someone with an MD. Often, doctors (such as internists or pediatricians) prescribe psychiatric medication to their patients without the patient ever seeing a mental health professional. Other times, people do see a mental health professional but cannot afford to remain in therapy on a long-term basis. Therefore behavioral or mood problems that cannot be fixed easily and quickly by psychotherapy are often treated with medication instead. Conrad towards the end of the book says:
It is worth restating that one reason for medicalization in our society is related to the way in which we finance human services. The only way individuals can get the services they want or need to be paid for is to define them as medical problems. Thus, there is an incentive to define problems as medical so that their treatment can be reimbursed by health insurance. This obviously encourages medicalization (160).
This is an incredibly important point. However, he waits until the last five pages of the book to make it. When discussing the various forces that influence medicalization, this seems an extremely important one. He mentions patient advocacy as a factor in medicalization, but seems to gloss over the bank breaking difference in whether or not they receive a medical diagnosis or not.
Similar to Dana, I have always had a difficult time with the medicalization debate and think that people are often too quick to look at the issue and say that many diagnoses are not "real" problems. At the same time, I also have a hard time with medicating a person, particularly a child, when other forms of therapy can make comparable progress. If insurance companies covered things like psychotherapy or alternative medicine, I suspect that the number of people medicated for psychiatric disorders would decline drastically. This is not to say that psychiatric disorders are not "real" problems or that people are misdiagnosed, but that taking a pill may not be the best solution for everyone, so it should not be the first automatic go-to solution for every patient. This all comes back to the lack of sufficient healthcare in this country, as well as the overwhelming power of the pharmaceutical industry. I am interested to discuss this topic and Carter's book further in recitation and in class, as it is a very hot topic, and is relatable to many of the subjects we have already discussed in class, such as disease vs. illness, low birth weight, and the social determinants of health.
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ReplyDeleteThe issue of medicalization always comes up in the world of psychology and psychiatry. Many argue that the over-diagnoses of certain disorders are due primarily to the way the insurance companies function in this country. Insurance companies only provide a limited amount of coverage and typically stop coverage unless a concrete diagnosis is made. Therefore, some mental health professionals are pressured to diagnose quickly without conclusive evidence that the disorder exists so that the patient does not lose coverage. In many cases, the slightest symptomology can lead to erroneous diagnoses.
ReplyDeleteAlso, when looking at medicalization from a macro level, I once had a professor who had very extreme views toward psychiatric diagnoses and those who come up with these disorders. He believed the authors of the DSM (diagnostic and statistical manual of mental disorders) worked with pharmaceutical and insurance companies when creating these disorders. He went on to say that every time a new disorder was put into this manual, 5 or 6 different types of drugs were created to supplement the disorder. He found it odd that there were more than 6 different diagnoses with over 30 supplemental drugs for a seemingly identical disorder with slight variation. He argued that the difference between some of these disorders were almost undetectable and were only added to the manual for the creation of more drugs. I’m not sure that I share his sentiment but I found it very interesting.
To touch on Kate's point, I agree that drugs are not ideal in every case and therapeutic approaches can be a more effective alternative. On the other hand, psychotherapy is oftentimes very lengthy and expensive and in many instances need to be supplemented with drugs to be effective. However, mental health professionals should not be pressured by insurance companies to prescribe drugs or stop therapy because a diagnosis has not been made. Furthermore, similar to Kate, I believe if the insurance companies changed their policies, psychiatric diagnoses would not necessarily decline but they would be more accurate and less rushed.
Medicialization obviously has its problems. I agree with Conrad and Dana in their view that our society has forced medicalization to certain peaks that are well beyond reasonable boundaries. For instance, the desire for certain people to view diagnoses as false is wrong and could lead to disastrous outcomes. However, medicalization's refusal to take into account many medical treatments that are not biologically based regardless of their effects is stunning. Such things as the connection between mental health and physical health is an example. Our science is limited in its explanation for the strength of this connection, and so pharmaceuticals and hospitals downplay its significance. However its applications such as the better treatment options of cancer patients through more intensive psychological treatment has been dismissed by the American Secretary of Health. On the other hand, experiments in Sweden and in Europe altogether show much success, albeit unexplained success, has come from testing the strength of the bond between mental health and physical health. Altogether, medicine has a problem with things it can't explain, but using that enigma is better then being lost without it.
ReplyDeleteI just finished writing a paper about how man made institutions fail to govern organic processes (ie. illness, death), and Conrad's argument definitely adheres to that idea. In reality, all humans have idiosyncrasies and unique chemical compositions; medicine is merely our attempt at providing general treatment for those who differ from the "norm." Governments and businesses (pharmaceutical companies, namely), have grown as interwoven entities that have a large influence on the healthcare we receive. Along with Dana and Conrad, I question our ability to truly "diagnose" or define a medical problem. Conrad writes, "Differences in learning styles become learning disabilities or ADHD; divergences in sexual desires or performance become sexual dysfunctions; extremes of behavior become sexual, shopping, or Internet addictions (e.g., Quinn, 2001); and individual differences become diagnoses such as social phobia or idiopathic short stature." While it is certainly beneficial to use standards of health for diagnoses, when it comes to behavioral and psychological "abnormalities," the lines between normal and pathological begin to blur. Our tendency to prescribe medicine to achieve a norm can be dangerous, putting the diversity of human mentality at risk.
ReplyDeleteI was going to quote the passage in Conrad's book that Gabrielle brought up because I think it cuts straight to the core of what the problems of medicalization are and what is going on behind the scenes. In general I am extremely cynical when it comes to the pharmaceutical industry and healthcare in America in general, and I would probably agree with a lot of the beliefs of Sammy's professor, particularly that the medical professionals are fully in bed with the pharmaceutical industries. I worked in a hospital two years ago and I saw the drug reps that would come in pushing the latest pills on the doctors for an endorsement. They were nearly always women in their mid twenties in a tight fitting dress and a million dollar smile. I just don't see how you can sugar coat it: healthcare in America is a business. The product is quite simple: hypochondria. And it's not even that hard to do in a society where we are constantly being told that we don't have the latest cool techno doo-dad and therefore are not sufficient as human beings. My favorite example of this creation of hysteria is this video about RLS: Restless Leg Syndrome: http://www.youtube.com/watch?v=AUsCxoShVqs&feature=related
ReplyDeleteI am very happy this topic was touched in the reading. The medicalization of anything can be controversial and I find it astounding that even in 2012 there is not a universal standard for illnesses tht are as broadly accepted as being diseases such as Schitzophrenia. The criteria to be diagnosed Schitzophrenic in Frnace for example varies significantly from that in the United States. People who have been diagnosed and treated here as having condition A may relocate to another Western and modern nation and be told they are not diseased at all or have disease B, something completely different than A.
ReplyDeletePills and diseases seem to come in fads and be in style the same way skinny jeans and v neck tees are. I believe there should be a more standardized system to eliminate or reduce many of these trends.
Medicalization imposes many problems when nurturing the mental health of adolescents into adulthood. It becomes engrained in us as children that almost everything in life, including health problems, can be skewed to belong in a category. I think that most people feel better having a label on something because the fear of the unknown is eliminated from the situation when a name is involved. Therefore, when someone's health shows signs of being atypical, even if it is temporary, it is understandable why some would assume there is a complication and demand an explanation for their feelings and behavior. This is not helped by the fact that there is a standard of normalcy and anything that isn't normal means that something is biologically wrong. Medicalization is absolutely overused, in what I think is an attempt to calm people's nerves so they have something to blame for when things go wrong. Finally, youth today has adapted to instant gratification, especially with technology making almost anything possible in a short amount of time. If someone is used to have something immediately, it would be very frustrating to feel tired, weak, depressed, etc. and feel entitled to an instant fix for these problems. Someone can very easily talk a progressional into prescribing medication if they emphasize certain symptoms that are well known and associated with certain illnesses. If individuals could learn to listen to their bodies more and tune out the media that puts a label on something as an explanation, maybe the overall health of people in this country would improve.
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