In this blog we will be examining at length the idea of ‘medicalisation’ and ‘medical imperialism’ as put forward by Ivan Illich. We will not only examine what it is, how it arose and how this process has shaped how people see medicine, but also the idea that this process may not always be undesirable. Different posts within this blog will examine the angle as it relates to different problems or aspects of society, and we will finish with a short conclusion on our discoveries of Illich’s medical imperialism.
Medicalisation is, in short, the idea that the medical industry is not simply a resource that is turned to when a person finds themselves with a physiological or psychological illness, but is instead an active participant in its own growth. If allowed to do so the medical industry will naturally expand first to the limits of what are normally seen as medical conditions that need to be fixed, and then beyond those and into the realm of bodily aspects or functions where traditional medicine may either not be necessary or may become actively harmful to the patient’s health (Illich, 1975).
To expand on this concept, Ilich (1975) also described the idea of medical imperialism, which takes this idea a step further: Not only will the medical field extend to control and influence the human body itself but it will reach past this and begin to assert authority and influence on a sociological level (Ilich, 1975). This can happen due to a variety of factors such as in order to extend influence or prestige on the part of the medical profession itself, for financial reasons in order to access previously-untapped markets, or for ideological reasons to maintain control over some aspect or demographic of society (Zola, 1975). This extension can even happen reluctantly, via pressure from outside sources such as investors in private health organisations, the general public if a public health crisis is seen to exist, or political figures who wish to create or influence the debate around a medical topic (DeSwan, 1989). In this way, medicalisation reaches beyond a doctor-patient relationship and influences society on a much larger scale.
The idea of medicalisation and medical imperialisation, and whether or not they are necessary or desirable, is heavily tied together with that of iatrogenesis. This is the concept that far from all medical intervention having positive results, treatments, prescriptions or products can in fact end up causing further medical complications in a variety of ways (Illich, 1975). These can range from problems such as less vital side effects, such as the ‘side-effects’ of many common over-the-counter medications, to some treatments or procedures being inherently more dangerous due to dealing with vital organs or utilising substances normally harmful to the human body, such as chemotherapy or major invasive surgery. These effects can even be psychological, with studies showing that some people who take medication expect side-effects, and in some cases will suffer from a placebo-like effect that causes non-specific mild discomfort (Barsky et al, 2002).
Directly related to the above concept, iatrogenesis and how it comes about is one of the core factors we must examine as a result of medical imperialism, but also the cause of a further reaction against medicalisation that has been taking place recently. A small but significant sample of patients now believe that their general practitioners and the medical establishment do not have their best interests at heart (Calnan and Sanford, 2004). Combined with other factors such as the rise of online self-diagnosis tools and various alternative medicines, this has resulted in a trend in some demographics towards ignoring medical advice entirely and relying on a variety of amateur or un-accredited ‘outsider’ sources for healthcare. This ‘de-professionalisation’ of medicine has come around due to a variety of factors that are tied into both iatrogenesis and expanding/imperial medicalisation. The largest factor however is the fact the field of medicine has undergone somewhat of a ‘de-mystification’ in the last two decades, mainly due to the advancement of the internet allowing previously-unavailable databases to become more accessible to people who have no medical expertise. Resources such as MD Online provide a comprehensive and searchable list of disorders and ailments that patients can refer to without the need of medical professionals. This has resulted in many patients who would otherwise rely on the medical establishment for diagnosis being able to do so in their own home with no supervision (Jagosh et al, 2011). Also this has resulted in a change in doctor-patient relations as doctors no longer find themselves merely ‘ordering’ an uninformed patient of their disorders but finding themselves forced into more in-depth conversations with patients who are fore-armed with knowledge of their possible conditions (Jagosh et al, 2011). This can be positive in the form of less patients playing a passive role within the diagnosis process from health professionals, but also negative in that the chances of common symptoms being misdiagnosed is extremely high (Ryan and Wilson, 2008).
That is not to say that these concepts cannot be criticised however, or that this blog will simply be agreeing 100% with Illich’s conclusions and theories. There is the argument to be made that medicalisation is not only beneficial but in some ways necessary to those who are sick and whose illnesses are not seen as such due to social reasons. For example until the late 20th century many aspects of mental health were not seen as disorders but as personal weakness or laziness and so people suffering from them were not seen as sick people (Parsons, 1975). According to Parsons (1975) the ‘sick role’ is necessary as it teaches people to conform to behavioural norms surrounding illness and therefore strays people away from deviant behaviours around sickness (Parsons 1975). Furthermore, Parsons (1975) claims that due to this, the medical industry is necessary as it teaches the role of sickness, contradicting Illich’s (1976) notion of medical imperialism and iatrogenisis. In cases such as these medicalisation can assist with disorders or problems receiving further study or investment (Broom and Woodward, 1996). In this way it can be argued that medicalisation can help to discover solutions to disorders via bringing them attention or money, or even to help de-stigmatize them.
For the remainder of this blog we will be exploring how these concepts work together in different areas.
By Andrew Elstob
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