Medicine (yay!) vs. Medicalization (boo!)

Sari van Anders

May 13, 2015

Once, an undergraduate student told me she was experiencing depression, but that she had been concerned about telling me she was on antidepressants. Why worry about telling me? I asked. She explained that she was worried I would think badly of her for using meds. I sat there, stunned, frantically running over the entirety of anything I had ever said to her or in front of her, wondering where this idea would have come from. Coming up blank, I asked her why she thought that. She explained to me that feminists were against antidepressants. Again, I was stunned, did the frantic scrolling-through-the-entire-history-of-the-world thing, and came up blank. Of course, I congratulated her for getting treatment, for discussing mental health when it is more typically seen as taboo, and we had a long discussion. And it hit me, then or a bit later, where this all came from…

Feminists are very often against medicalization, but almost none are against MEDICINE. Do those words look too similar to mean different things? Kind of, eh? I mean, objectively they are different words, but they are so same-lookish! Maybe one is just a fancy way of saying the other? Nope. Medicine and medicalization are not the same. Even if they have the same first five letters!

Would you like some fancy definitions for the terms that I just made up? OF COURSE YOU DO! Medicine’s fancy definition: something you put in/on your body to reduce the negative effects of illness/sickness/bad health. And part of defining a term is thinking about who are the experts for that term. So, who is an expert on medicine?

[Picture of Jon Bon Jovi singing into a microphone]

Jon Bon, expert on bad medicine.

Bon Jovi, obviously. This is what Jon Bon says: Your love is like bad medicine | Bad medicine is what I need | Shake it up, just like bad medicine | So let’s play doctor, baby | Cure my disease. Wow. That’s a bit confusing because why does anyone need bad medicine? And, is it all medicine that needs to be shaken, or just the bad kinds? Who else is an expert on medicine? Doctors, pharmacists, some biomedical researchers, epidemiologists, all in addition to Bon Jovi, the reigning champion.

Ok, now for the fancy definition of medicalization: something that unnecessarily grabs a phenomenon from the ‘regular life’ box and puts it into the medical domain box. Who is an expert on medicalization? Here, Bon Jovi lets us down as does music in general (try to get on with life, though) – there are no songs, brilliant or otherwise, about medicalization. Who is left to be an expert on medicalization, then, without the frosted hair contingent? Sociologists of medicine, feminist scholars, medical anthropologists, people with the lived experience of whatever’s being medicalized, and other critical thinkers.

Well! Easy peasy lemon squeezy! Medicine means one thing and medicalization another! Phew.  Medicine = good; medicalization = not so good. Except that the line between the two isn’t so clear. In fact, that blurriness is kind of the point of the concept of medicalization: on one hand, medical folks think a phenomenon IS a legitimate medical target while, on the other hand, scholars and community folks do not. Who is right? This is a case of ‘competing knowledge claims.’ How do we decide which knowledge claim (medicine! or, medicalization!) is right? Helen Longino, a superfamous feminist philosopher of science, argues the only way we do this is with a “community of knowers,” which is a fancy way of saying ‘people.’ But she also argues that this community needs to be diverse. So, you can’t just have, say, MDs arguing over whether something is medicine or medicalization – in fact, the question of whether a thing that is already IN medicine might actually be not-medicine would probably not-occur to most or many mediciney people.

Tricky question: are pharmaceutical companies and their people experts on medicine? Some would argue that they can be experts on medicine but also that they are expert medicalizers. For example, they might have a medicine but no disease! What to do in that case?  The case of the missing disease? Make one up! Critical scholars have demonstrated how diseases sometimes get manufactured so that an existing no-use medicine can be sold. Or, how something that is regular (like balding in men, or small breasts in women) gets repackaged as a disease that can be solved by 10 easy installments of $$$ CALL NOW!

So the line between medicine and medicalization can be blurry because people with differing perspectives and goals will argue about whether the same phenomenon is one thing or another. But the line can be blurry in another way. For example, I’m super preggers, if by ‘super’ we all agree to mean having a really superior experience of the worst parts of pregnancy but don’t worry: if you get pregnant, it will be the best part of your life I PROMISE BECAUSE I HAVE THAT KNOWLEDGE AND POWER. So, why is my pregnancy the worst? Well, I’ve spent many months in bed or on the couch, super nauseous and vomity and uncomfortable and NO, GINGER WILL NOT HELP and YES, I AM ALREADY IN THE SECOND TRIMESTER AND I’M STILL CRAPTASTIC and PLEASE, SOMEONE BUILD A TIME MACHINE SO I CAN FAST FORWARD TO THE BIRTH NO WAY AFTER THE BIRTH NO WAY TIL THE KID IS FIVE YEARS OLD.  So, it’s pretty bad and I’ve been doing a lot of complaining (hey, do what you’re good at, eh?). My friends were all like: um, hey you friend of mine, do you know about this medicine for pregnancy nausea? And I was like yes, thank you, but things aren’t that bad yet. As things got worse, and my complaining ramped up, these friends were like: hey you friend of mine, seriously, there’s this medicine. For pregnancy nausea. Get it. Take it. And I was like, sure, when things get bad enough. Why? Because so much of pregnancy is medicalized, and I was trying to find the personal line between medicine and medicalization (and, no, I don’t need a ‘talking-to’ in the comments).

I mean, look, I’m a feminist scientist, a reproductive sciences person, a hormone researcher, and etc. I am generally pro-medicine and anti-medicalization. But knowing the difference in individual cases can be a nontrivial problem. Is taking anti-nausea pills self-medicating or self-medicalizing? Does it turn an incredibly common (horrifically so, given how debilitating it is) and regular part of the pregnancy “experience” into some sort of disease-like condition/state? I mean, my physical health wasn’t actually compromised since I was able to eat and, mostly, keep food down (sometimes women or other people gestating can’t, and very clearly need medical support to even just live). My psychological health was definitely another story: it’s a miserable situation. Obviously, each person is going to have to figure this out for them. Once I finally decided the meds were medicine I took them and never looked back, feeling so much better, and happy with my choice.

So, the line between medicine and medicalization can be blurry, because what counts as a medical problem can be culturally situated (should there be a pill for lots/not much hair? are sticky-outy ears a medical issue? do periods have to be regular?). And, it’s not even always the case that we boo medicalization, because sometimes there might be benefits to putting something in the ‘medical’ box. Still, the presence of medicine (or a pill or a surgery) doesn’t magically transform whatever the medicine is for into a disease UNLESS YOU ARE HARRY HOUDINI AND THEN I RESPECTFULLY WITHDRAW. Feminism is, in part, about engaging with these distinctions (about medicalization vs. medicine, not Harry Houdini YET) even while supporting medical choices. Yes, there’s a tension there, but where isn’t there? (milkshakes.)