PolyU-Hong Kong Community College

AD Scheme in Health Studies

CCN2040 Sociology for Health Studies
Lecture 5-6 Social Constructionism,
Medicalization and its Critiques
 Key Questions

What are the main ideas of social

constructionism?

What is medicalization?

What are the problems of over-medicalization

to us?
Social Construction of Illness
Our definition of health and illness changes over
time (e.g. heavy drinking, mental disorder, dyslexia,
anorexia, sexual dysfunction... etc)

Discovering disease requires identification and

classification, which entails different social values
and assumptions about what is health (normal) and
illness (abnormal).

The disease categories justify medical control and

legitimize the expense of medical care for that
disease, and institutionally establishing treatment
programs.
Hypotrichosis
Do you have
any of these
symptoms?
 What is mental illness?
"a syndrome characterized by clinically significant disturbance in an individual's
cognition, emotion regulation, or behavior that reflects a dysfunction in the
psychological, biological, or developmental processes underlying mental
functioning. Mental disorders are usually associated with significant distress in
social, occupational, or other important activities.”
(Diagnostic and Statistical Manual of Mental Disorders -5) [DSM-5])

What kind of problems would bring to us if we have disturbance

in the following areas?

Cognitive:___________________________________

Emotional: __________________________________

Behavioural: _________________________________
 Critical Thinking

What does it mean by “clinically significant

disturbance”?

What does it mean by“dysfunction”?

What causes the the distress?

 Diagnostic and Statistical Manual of Mental
Disorders

Diagnostic and Statistical Manual of Mental Disorders-5 [DSM-5]

Published in 2013
the “psychiatric bible” for psychiatrists, health insurance companies,
pharmaceutical companies……
Divides mental disorders into types based on criteria sets with defining
features. It works best when:
all members of a diagnostic class are homogeneous
clear boundaries between classes
the different classes are mutually exclusive.
 Critical Thinking

Is the expression of symptoms homogenous in

the same category, such as schizophrenia?

How to determine what counts as symptoms?

DSM diagnoses are based on a consensus about
clusters of clinical symptoms, not any objective
laboratory measure
 More examples from DSM5
People with high level of health anxiety with somatic symptoms (with or
without medical explanation of symptoms)—> Somatic symptom
disorder (SSD)

People with high level of health anxiety without somatic symptoms

(previously known as hypochondriasis) —> Illness anxiety disorder

A child with pattern of angry/irritable mood, argumentative/defiant

behaviour, and vindictiveness —> Oppositional defiant disorder (ODD)

Women with insufficient sexual desire/arousal—> Female sexual

dysfunction

Person with “problematic” gambling behaviour for a year

—> gambling disorder
 Gambling Disorder (DSM5)
A Persistent and recurrent problematic gambling behavior leading to clinically
significant impairment or distress, as indicated by the individual exhibiting four (or
more) of the following in a 12-month period:
1 Needs to gamble with increasing amounts of money in order to achieve the
desired excitement.
2 Is restless or irritable when attempting to cut down or stop gambling.
3 Has made repeated unsuccessful efforts to control, cut back, or stop gambling.
4 Is often preoccupied with gambling (e.g., having persistent thoughts of reliving
past gambling experiences, handicapping or planning the next venture, thinking
of ways to get money with which to gamble).
5 Often gambles when feeling distressed (e.g., helpless, guilty, anxious,
depressed).
6 After losing money gambling, often returns another day to get even (“chasing”
one’s losses).
7 Lies to conceal the extent of involvement with gambling.
8 Has jeopardized or lost a significant relationship, job, or educational or career
opportunity because of gambling.
9 Relies on others to provide money to relieve desperate financial situations
caused by gambling.
Medicalization of Mental Illness
'In the days of the Malleus, if the physician could
find no evidence of natural illness, he was
expected to find evidence of witchcraft: today, if
he cannot diagnose organic illness, he is expected
to diagnose mental illness.'

Thomas Szasz
 Critique of Mental Illness (Thomas Szasz)

Mental illness is only a metaphor—

The term “illness”implies a demonstrable biological

process; however, mental illness actually refers to
undesirable thoughts, feelings and behaviours of persons.

There lacks concrete scientific evidence to prove the link

between these the brain and most behavioural symptoms.

The judgement of symptom is tied to the social context

rather than the anatomical and genetic context.
“Mental illness” are the expression of people’s struggle with
the problem of how we should live. It is the problem for
everyone.
 Critique of Mental Illness (Thomas Szasz)
The illness classification provides an ideological
justification for state-sponsored social control as medical
treatment. Psychiatry controls thought, mood, and
behaviour, like Church and State.
People with mental illness should not be assumed to be
mentally incompetent, and the incompetence should not be
based solely on the basis of opinion of mental health
experts. Insanity defense should be banned.
Involuntary mental hospitalisation should be abolished as
it is a form of social control that subverts(削弱） the rule of
law. No one ought to be deprived of liberty except for a
criminal offense, after a trial by jury guided by legal rules
of evidence.
 Medicalization
Medicalization is a social and historical process that defines
non-medical problems as medical ones. It normalizes human
behaviours.

1. Defining natural biological processes as sickness requiring

pharmaceutical, surgical or therapeutic interventions.

2. Extending the pre-existing medical categories to include

more potential sufferers and situations

e.g Childbirth
e.g. Ever-increasing number of disorder defined: DSM-I (106) —> DSMIII (265)—
>DSM-IV (365)—> DSM-V (same as DSM-IV by re-grouping disorder into a sub-
type of another disorder)
 Medicalization

A three-layered analysis of medicalization:

Conceptual

Institutional

Interactional
Medicalization of ‘Madness’: from badness to sickness
In premodern societies, family managed the abnormal people and
normalized madness by explaining away problematic behaviour as mere
eccentricity.
Before the modern scientific age, societies viewed “madness” as a
punishment for sin or violating a taboo, a sign for being a witch, or as
affected by devils, spirits or witches.
In the 17th century, houses of confinement were used to accommodate ‘mad’
people, such as beggars, criminals and prostitutes. The conditions in these
houses are miserable. People with madness were believed to be incurable
and essentially animals. Although these houses of confinement became
specialized later, the rationale was not medical. It was social and economic.
During the 19th century, madness began to be defined as a medical issue,
requiring medical (e.g., neurology) and scientific interventions. The growth
of asylums further consolidated the authority of psychiatrists.
The rise of psychoanalysis, study of genetics and the invention of ‘mood
altering’ drugs reinforced the medical nature of medical illness.
Medicalization of Mental Disorder

Invention of mental disorder:

http://www.youtube.com/watch?v=qwaEWIu3FZ0&list=PLE63BF146E10E32E1

(0-8:27)

Side Effect of Psychiatric Drug:

https://www.youtube.com/watch?v=gWup_J
MVHfQ&list=PLE63BF146E10E32E1&index=8
(0-3:07)
 Drives of Medicalization
Parties involved in medicalization: doctors, pharmaceuticals, insurance
company, active agents from grassroots
Disease mongering:
Pharmaceutical companies sponsored researches define and classify
new medical disorder at company sponsored meetings.
Medicalizing natural human conditions gives drug companies a
reason to make more drugs and profit.
Emergence of medical markets and consumers. Active patients may
help promote medicalization as well.
Medicalization is bidirectional. It is related to how we finance medical
services.
e.g. Insurance company can both promote or limit medicalization.
Social Consequences of
Medicalization
Extends the sick role --> reduce individual
blame for the problem (e.g. ADHD)

Reduce the stigma and let individuals function

better (e.g. treating Anorexia)

Improvements after taking

psychoactive drugs
 Over-medicalization:
Social Consequences
Pathologizing everything: transforming many
human differences into pathologies

Would it diminish our tolerance and appreciation of the

diversity of human life?

Redefining ab/normality: e.g. impotence, social

anxiety disorder (SAD)

Does problems with a biological basis necessarily

become a medical problem?
 Social Consequences
Expanding medical social control (controlling social
behavior with medical advices and even therapies)

Extending control to individual-at risk (medical

surveillance)

More forms of behavior are no longer deemed the

individual’s responsibility

Individualization of social problems: treat the individual

rather than the social cause (e.g. Depression, learning
disabilities)
Ivan Illich (1976):Iatrogenesis
Iatrogenesis: “doctor-caused illness”

Clinical iatrogenesis: damage done by medicine to the

health of the individuals and populations.

Social iatrogenesis: definition of human conditions as

medical problems.
~~ Sisyphus Syndrome: modern health care may keep
people alive but with chronic diseases, and require yet
more health care.

Cultural iatrogenesis: dependence on medicine to cure

and to care for. Medicine “robs” people’s ability to
care for their own health.