The purpose of this blog is to comprehensively examine the concepts of medicalisation and Illich’s medical imperialism, whilst evaluating and critiquing to what extent these two concepts impede on a range of issues and areas within contemporary society. Throughout several posts on this blog how medicalisation operates will be assessed along with how it has helped create categories of normal and deviant bodies. Through separately evaluating issues regarding topics such enhanced bodies through the use of cosmetic surgery and the designer vagina, gay men’s bodies and HIV and AIDS it will be possible to see the relevance of Illich’s theory today. This blog will conclude with a short summary of the extent to which the medical imperialism theory is still relevant, when applied to contemporary social issues.
Medicalisation is a process by which the nonmedical, or social phenomena, is transformed into a medical ‘problem’; Conrad (2007) claims the key to medicalisation is definition, when a human condition begins to be defined in medical terms, using medical language and frameworks, medical treatments can be used to solve the perceived problem. Thus, a process of medicalisation takes place. In recent years medicine has developed into a ‘major institution of social control’ and ‘repository of truth’ in which individuals seek out the advice of the medical establishment and accept it, mostly, as truth (Zola in Scott, 2006; p100). This had led to almost all individuals living in what De Swaan (1990; 57) claims is a light medical regime, in which individuals survey their behaviour via fitness and hygiene to avoid a ‘small chance of a great misfortune’ occurring; this has helped also to create what Beck (1992) would consider a risk society in which individuals attempt to weight up benefits and risk in order to avoid unpleasant occurrences, this can often manifest itself in intense risk aversion.
This leads into the concept of medical imperialism, a term developed by Illich (1976) in which he argues that the expansion of the medical field allows it to not only control the physical being but the medical establishment can then reach, justify and legitimate a dominance on a sociological and cultural level. Illich Medical imperialism can occur for a number of reasons, such as the desire to gain power and monopoly in terms of money (De Swaan, 1990); individuals are also able to influence this. For example, those with political or other social influence are often able to push medicalisation on to others in order to fulfil or benefit their own agenda. For example, large pharmaceutical companies who aim to get a monopoly over other pharmaceutical organisations and make the biggest profit. However, Zola (in Wainwright, 2008) points out that medicalisation and medical imperialism are so accepted in contemporary society that the achievement of health is now strongly associated with Western culture. The influence of outside forces such as political, celebrity and pharmaceutical figures is one way in which medical expansion can reach above and beyond the basic realm of doctor-patient relations; a factor in medicalisation which is also changing.
The expansion of the medical establishment can cause significant physical and cultural damage on several levels, which is one factor that influenced Illich’s intense opposition to the expansion of medicine into everyday life. This physical, social and cultural harm is known as iatrogenesis (Illich, 1976). Iatrogenesis can manifest itself in a number of ways such as through psychosomatic illnesses in which individuals present with non-discernible physiological discomfort from placebo drugs such as sugar pills, it can also manifest itself in authentic physiological adverse effects from drugs, such as allergic reactions or intrinsically risky, but not necessarily essential surgical procedures (Sharpe and Faden, 1998). Finally, it can manifest itself ideologically in terms of how individuals view the human condition, illnesses and the sick, therefore Illich claims there is a greater need for spiritual and personal dimensions of medical care (Moon and Gillespie, 1995). An appropriate example of the harmful ideological perceptions of sick individuals is outlined in Parson’s (1951) concept of the sick role in which individuals must meet specific conditions in order to be labelled as sick, such as seeking medical help to get well. However, if individuals are not able to get well or not viewed as sick where physiological signs cannot be found, people may find themselves socially isolated; friends and family may lose patience with them, meaning they become increasingly dependent on less people (De Swaan, 1990). Nonetheless, this can also be viewed as an opposing view of Illich’s idea that medicalisation is unnecessary as Parsons (1951) claims sickness is a necessary form of deviance to illustrate to others how one should behave when sickness befalls themselves and how to return to normal social roles.
Bradby (2012) points out that since the development of the medicalisation and medical imperialism thesis a decline in power of the medical profession has been documented, however this may not necessarily be due only to the medical imperialism thesis. Cockerham and Cockerham (2010) outline that globalisation and technological advances have led to an increased ability for individuals to self-diagnose at home using technologies such as Web MD and the NHS online website in order to check symptoms, view possible medications and self-medicate where necessary. A “self-service” type of care has not yet fully taken hold within the medical profession, although this may have contributed significantly to the de-professionalisation of physicians (Pescosolido, 2013) in which they are becoming alienated from the intrinsic nature of their work. De-professionalisation and globalisation may have also contributed to the changing nature of doctor-patient interaction during consultation.
Whereas Navarro argues that the very form of medicalisation is another part of social control on society and that its only relevance to society is that it benefits the most powerful members within society such as individuals who appeared to be in the ruling capitalist class bracket. Meaning that medicalisation serves a purpose of defining a medical problem within medical terms which goes by a medical framework to understand different medical problems and to therefore treat them (Busfield, 2017).
The following posts found on the blog will cover a number of topics and will assess the relevance of Illich’s concept of medical imperialism when applied to contemporary social issues.
By Katherine Simpson
Critique from Navarro’s perspective by Kelly Stanley
Medicalisation of Society 