(originally posted to Technoscience as if People Mattered January 14, 2015)
Disparities in health outcomes along racial, gender, and class lines are increasingly prevalent, and we don’t have to search for long to find media coverage of the spiraling costs of health care. Understanding medicine as a social phenomenon is thus now more important than ever. The book Biomedicalization: Technoscience, Health, and Illness attests to the increasing universality of the application of medical thinking to “normal” life, saying, “health itself and proper management of chronic illnesses are becoming individual moral responsibilities to be fulfilled through improved access to knowledge, self-surveillance, prevention, risk, assessment, the treatment of risk, and the consumption of appropriate self-help and biomedical goods and services.”
There are two concepts, medicalization and biomedicalization, that an STS scholar might use when studying the sociocultural effects of the institution of medicine.
What is Medicalization?
Medicalization, an idea that originated with Irving Zola and Peter Conrad, is the process by which social issues become medical ones. Social phenomena that were originally perceived as moral or legal problems such as addiction and homosexuality became medical conditions via the process of medicalization. A hallmark of Medicalization is the widespread acceptance of medicine and medical authority.
Although it is generally more useful to conceive of medicalization and biomedicalization as processes that can work in unison and not as eras, medicalization was most prominently at work during the period from post-WWII until about 1985. (The era prior to Medicalization consisted of contested territories of healing and illness. It was here that allopathic medicine struggled – and eventually succeeded – to establish itself as the dominant and eventually exclusive authority over health.)
Medicine is an arena of life where science is inserted into the most personal of human experiences (pain, humiliation, suffering, need, death, birth), which makes it crucial to investigate the risk of abuse in these interventions on a social and not just individual scale, and we use medicalization as the tool to do that.
What is Biomedicalization?
Biomedicalization is a process of technoscientific change that has been occurring since roughly 1985. Biomedicalization is concerned with the definition of life and with medical interventions designed not just to extend life and promote health but to enhance our biological selves (via interventions like cognitive enhancements or cosmetic surgeries). It places a significant emphasis on genes.
Five key concepts encapsulate biomedicalization:
- Privatization and Commodification
- Clarke et al. neatly describe the complicated interdependent relationships between various profit-driven entities that make up modern biomedicine as “The U.S. Biomedical TechnoService Complex Inc”.
- Risk and Surveillance
- Health and disease management becomes an individual moral responsibility.
- Expanding Technoscientific Practices
- This includes computerization of both record-keeping and medical functions, advanced imaging technologies, and organ transplantation.
- The Production and Distribution of Knowledges
- This results in a subsequent increase in individual responsibility for knowledge possession; that is, now that it is so easy to obtain, individuals have a responsibility to have that information.
- Transformations of Bodies and Subjectivities
- The role of medicine changes from performing bodily normalization (treating or “curing” disease) to bodily customization, and new technoscientific identities are created through biomedicine. Biomedicine influences identity in a number of ways, including enabling the attainment of a desired social identity (for instance, “mother”), defining the concept of “healthy person”, and categorizing groups as “low” or “high risk”.
Biomedicalization focuses on risk as the primary consideration in health care decision-making, works to transform the human body or its constituent components into products, and ultimately matters to readers of this blog because it brings to bear the lens of technoscience on the longer-standing tradition of investigating medical sociology.
Distinguishing Between the Two
The distinction between medicalization and biomedicalization can certainly be difficult to fully delineate. These two processes can be at work at the same time, but it is useful to view biomedicalization as a theoretical heir to medicalization; its concepts are further developments of the basic ideas of medicalization, and this perspective of biomedicalization as subsequent to medicalization is particularly supported by its focuses on modernity (the notion that we are currently living in an exceptional era because of science/technology/medicine) and the social implications of cutting edge medicine.
Interventions in the Medicalization era addressed symptoms. In the biomedicalization era, they are performed before disease progresses to the stage of perceptible symptoms. Medicalization investigates medical control over biological phenomena, while biomedicalization emphasizes (technologically-based) transformation.
Clarke et al. offer a clear example of the difference between the two saying that medicalization strives to answer questions like, “How does medicine control women?” while biomedicalization tries to address, “How does medicine do the work of gendering?” So, medicalization might look at ways that conditions present in women and not men are cast as disease or disorder (e.g. hysteria). Biomedicalization will look at how medical texts, conventions, and understanding work together to construct the male body as natural and neutral (e.g. the discrepancy between availability of contraceptives targeted at each gender).
A reasonable heuristic for conceiving of these differences is that the processes, questions, disorders, and methods of biomedicalization research are newer, tinier, and/or more technological.
The concept of medicalization gives us a way to view more clearly the often seemingly inevitable process of medical progress as a complicated and social phenomenon and often a replica of existing social phenomena. Biomedicalization lets us add to that a consideration of the nuance and complexity inherent in an increasingly technical world turning increasingly to technoscientific solutions for diverse problems. These tools will continue to be relevant for social investigations as health care and its impacts continue to play such a major role in the social world.