HGA339 Sociology of Health and Illness Assessment Task 1

Lachlan Nicolson Student ID: 124670

Depression or Sadness? An Analysis on the Concept of Medicalization

Introduction Medicalization has become an increasingly observed phenomenon in many contemporary societies. This paper will discuss the concept of medicalization before examining the possible consequences and benefits of the process using the example of depression. It suggests that in recent times we may be experiencing a medicalization of everyday sadness. Finally, this paper will conclude that further investigation is required in order to properly understand the context of sadness and depressive illness in regards to medicalization. The Concept of Medicalization Over the last four decades, the concept of medicalization has been developed through literature with origins in the works of Irving Zola, Peter Conrad and Thomas Szasz. Though the term has become increasingly prevalent in sociological literature, there are variations in the ways this concept has been defined. Conrad, Mackie and Mehrotra (2010: 1) define medicalization as the process by which non-medical problems become defined and treated as medical problems, usually in terms of illnesses, disorders or disorders. Conrad (1992: 211) further explains medicalization as [consisting] of defining a problem not previously seen as medical in medical terms, using medical language to describe a problem, adopting a medical framework to understand a problem, or using medical intervention to treat it. Finally, Zola (1983: 295) suggests that medicalization is a process whereby more and more of everyday life has come under medical dominion, influence and supervision. Ultimately, medicalization explores the notion of human conditions and problems becoming the subject of medical treatment, study, diagnosis or prevention as a result of being defined as medical conditions. Sociological literature of medicalization is generally more skeptical about the phenomenon. It tends to place greater emphasis on the negative aspects and at best remains ambivalent about the gains and losses that can occur (Conrad 1992: 210). Common critiques focus on aspects such as the assumption of medical moral neutrality, domination by experts, individualization of social problems, depolitization of behavior, dislocation of
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HGA339 Sociology of Health and Illness Assessment Task 1

Lachlan Nicolson Student ID: 124670

responsibility, using powerful medical technologies, and the exclusion of evil (Conrad 1992: 224). Such attacks are grounded in concerns of how social problems are decontextualized and brought under medial jurisdiction. As Conrad & Schneider (1980: 245-52) note, medicalization individualizes what might be otherwise seen as collective social problems. Other prominent critiques suggest that medicalization has pathologized everyday life, may be tied to greater economic interests, raises concerns about the increasing power of medicine and may result in adverse effects or complications as a result from medical advice or treatment. Despite such critique, it is important to note that medicalization is also associated with benefits. These include increased opportunity to alleviate or reduce suffering as well as the removal of culpability from a person whose condition may otherwise be viewed as a result of their being deviant or bad. Further, as Ballard and Elston (2005: 228) suggest, initial accounts of medicalization may well have over-emphasized issues of medical dominance and the imperialistic tendencies of the medical profession whilst also [underplaying] the benefits of medicine. Depressive Illness and the Medicalization of Sadness There are many examples of disorders which have been supposedly relocated from the realm of everyday life and to the authority of medicine. The medicalization of conditions such as snoring, hair loss, over or under-eating, gambling and even sexual dysfunction has resulted in what some purport to be a pill for any ill healthcare in many contemporary societies (Thomas 2009: 25). This paper however, wishes to explore the notion of the medicalization of sadness. The World Health Organisation (WHO) has predicted that by 2020, depression will be the second largest disease by burden worldwide (Murray & Lopez 1996). Epidemiological studies have consistently reported that depression has significantly increased during the latter part of the 20th century (Mulder, 2008: 240). Further, we are now seeing unprecedented rates of earlier onset of the illness (Weissman et al. 1996). This paper hypothesizes a number of possible explanations for the apparent increase in depression in recent times. Firstly, there may be an actual epidemic of depressive illness. This is a frightening prospect as it suggests that depression both exists as a natural entity, and is rising significantly among members of many Western societies.
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HGA339 Sociology of Health and Illness Assessment Task 1

Lachlan Nicolson Student ID: 124670

Secondly, the increase in depression may be a product of the over-encompassing nature of the diagnostic criteria for depression. For many contemporary Western societies, the diagnostic criteria for depression are determined by the American Psychiatric Association and published in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). This manual provides standard criteria and a common language for the classification of mental disorders. Whilst it is important to note that the introduction to the DSM-IV acknowledges that its illness definitions are all human constructions, professionals such as mental health workers generally regard depression as a natural entity and a specific mental illness rather than a construction (Mulder 2008: 239). Its concept of depression is understood as an expression of medical naturalism (Mulder 2008: 239). Some sociologists have argued that these diagnostic criteria do not make a clear distinction between abnormal sadness due to internal dysfunction or depression . . .and normal sadness (Horwitz & Wakefie ld, 2007). That is to say that the DSM does not properly differentiate between sadness without an identifiable cause and sadness with a clear cause. Ultimately, this explanation looks to the possibility that people presenting symptoms concurrent with these criteria may be experiencing deep yet normal sadness as a result of many types of adverse events or loss. Whilst the DSM does exclude people from being diagnosed if they are experiencing the loss of a loved one, this paper suggests that there may be many life events that could trigger a normal human response of sadness. Thus, attention should be paid to the context of the symptoms (Dur-Vil, Littlewood & Leavey 2011: 166). Although the current DSM definition of depression may inappropriately include sadness that may occur as a natural response to life events as opposed to a mental disorder (Horwitz & Wakefield 2007), many still support the diagnostic criteria and raise issues such as concern for individuals who may miss out on treatment if they go undiagnosed (Hickie 2007; Pies 2009). Linked to this is the explanation that suggests that social constructions around what is defined as normal and abnormal are shifting. As Mulder (2008: 241) notes, the symptoms of depression that reside in these cultural rules have changed across different historical eras. Symptoms such as unproductivity, persistent unhappiness, low energy and a lack of motivation that were understood as somatic or social ailments in the 18th and 19th centuries are now conceptualized as illness.

HGA339 Sociology of Health and Illness Assessment Task 1

Lachlan Nicolson Student ID: 124670

A final explanation suggests that powerful agents or figures of authority within the medical industry may be elevating rates of depression, or the diagnosis of depression, as it serves their interests and offers financial incentives. This worrying approach suggests that actors such as powerful drug and pharmaceutical companies may be attempting to increase their target market for depression and subsequently their sales and profits. As Moynihan, Heath & Henry (2002: 886) put the social construction of illness is being replaced by the corporate construction of disease. This may occur through so-called disease mongering, the sponsorship of medical education, depression awareness campaigns and conferences as well as funding research for new medications and the influencing of the prescribing habits of doctors (Mulder 2008: 240-241). For example, laws in New Zealand currently permit pharmaceutical companies to donate gifts, equipment and money to hospitals and private practices (Thomas 2009: 28). This possibility may be understood as either benefiting the public through the distribution of important awareness information, or as a self-serving endeavor. As we can see, with the exception of the first hypothesis, the possible reasons for the apparent increase in depression in recent times are largely related to what may be understood as the medicalization of sadness. This paper suggests that further investigation into these factors is necessary in order to gain a better understanding of depressive illness.

Conclusion Since its mainstream emergence in the late 20th century, the concept of medicalization has become both a prominent and controversial topic in the literature of sociology of health and illness. Though frequently critiqued for its overly dominant nature and the individualization and decontextualizing of social problems, medicalization may not be as straight forward to understand as early theorists asserted. The often underplayed benefits and changing nature of medicalization in todays post-modern era set the framework for a need to further investigate this phenomenon. This paper looks at the significant rise in depression we are currently witness to and the possible explanations for this occurrence. Factors such as the broad nature of diagnostic criteria, changing cultural understandings of normal and abnormal symptoms and the influence of powerful agents of social control such as large pharmaceutical companies may all be contributing to a medicalization of
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HGA339 Sociology of Health and Illness Assessment Task 1

Lachlan Nicolson Student ID: 124670

everyday sadness. However, mental illnesses must be taken seriously and not simply brushed off as a social construction or misdiagnosis. In order to better understand the nature of depressive illness, this paper posits that we must look deeper into the contexts surrounding depression, sadness and its relationship with processes of medicalization.

HGA339 Sociology of Health and Illness Assessment Task 1

Lachlan Nicolson Student ID: 124670

References
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