Text by Franziska Boll (Freie Universität Berlin)
© Pablo Dohms
According to Peter Conrad, “medicalization describes a process by which human problems become defined and treated as medical problems, usually in terms of illnesses or disorders” (2017, 210). Therefore, the term medicalization has a strong political dimension, as it has great implications what kind of behavior is considered as abnormal or sick. As I will point out in the following there is nowadays also a connection to psychopharmaceuticals, as the categorization of a human problem as a medical one often leads to a prescription of psychotropic drugs.
I will take a look at different examples of medicalization: First, I will cover medicalization of academic distress, and secondly, I will focus on medicalization of life in the age neoliberalism. Lastly, I will explore the interface of psychopharmaceuticals and local economies.
Medicalization of academic distress and self-enhancement
My first observation relates to my studies in South Korea, where I spent one semester to study Social Anthropology and International Communication. I became friends with Mary[i], a girl from the USA. She was very stressed about her grades as they influenced her scholarship, which she needed to be able to afford university fees. As studying in South Korea followed a different system which required more memorizing than she was used to, she was very worried about her grades decreasing. So, when her girlfriend who had a subscription for Adderall visited her, she asked her to bring some, so she could study the last week before her exams nonstop without getting distracted. I was worried about her because I thought she might take on too much and get too focused on her work without taking breaks or eating sufficiently.
As Jack Levinson and Kelly McKinney write in their text “Consuming an edge: ADHD, stimulant use, and psy culture at the corporate university” students might employ “neoliberal management strategies” to increase their academic performance through medication (2013, 371). This entails taking Adderall in accordance with academic demands with or without prescription.
Levinson and McKinney paint a complex picture by emphasizing the blurring line between treatment and enhancement. In interviews with three students who had been diagnosed with ADHD the authors found out that some students take Adderall not as prescribed, but strategically in relation to academic demands which makes it hard to categorically differentiate between enhancement and treatment (2013, 373).
They also found that a wider circle of students, who were taking various pharmaceuticals against depression, anxiety or ADHD, all described the academic demands of college as ‘‘heavy’’ or ‘‘intense,’’ and regarded their medication as helping them to function in college (2013, 374). Therefore, Levinson and McKinney draw the conclusion that there is little difference between academic stress and psychiatric distress. By considering the role of college mental health services in the expansion of the medicalization of personal and academic distress, they argue that pharmaceuticals are being used to manage academic tasks and that this “illustrates how psychiatry unwittingly medicalizes personal and social problems” (2013, 384). I would draw from the term “medicalization of a social problem” that a problem which could be solved through different means like political solutions is addressed by psychopharmaceuticals.
Luigi Esposito and Fernandez Perez draw a similar conclusion in their paper “Neoliberalism and the Commodification of Mental Health” as they also see a medicalization of social problems. Just like Levinson and McKinney they also name ADHD medication as an example to enhance personal focus and competitive behavior (2014:431). They conclude that instead of working on the social circumstances like reducing stress in college, the problem is solved through medication and medicalization: “We’ve decided as a society that it’s too expensive to modify a kid’s environment. So, we have to modify the kid” (Esposito/Perez 2014, 430).
My friend Mary was also very stressed because her education was expensive and required her to get into debt. Her parents could not or would not support her financially, so she took on a loan and was worried about increasing it or not finding a job to pay it off afterwards. Besides the pressure to achieve good grades to be successful later, her concerns were also tied to immediate economic constraints as she would lose her partial scholarship if her grades decreased. Lowering the costs for education could be a starting-point to decrease stress in US-American colleges.
Medicalization of life and neoliberalism
Neoliberalism plays a central role in Esposito and Perez´ paper as well as in Levinson and McKinney analysis, by referring to neoliberal management strategies. But they do not provide a definition. I wondered, what exactly does neoliberalism mean and in which contexts is it used as an analytic explanation?
According to Taylor Boas and Jordan Gans-Morse the term “neoliberalism” is often employed in current academic papers but rarely defined. They analyze its usage and conclude that it is mostly applied with a negative connotation by people who are critical of free markets and “often denotes a radical, far-reaching application of free-market economics” which was not the original meaning of the term (Boas/Gans-Morse 2009, 441).
Esposito and Perez state that they associate neoliberalism with market society. Besides policy prescriptions it causes a form of neoliberal thinking: “Neoliberalism supports a type of order and vision of the world in which all aspects of social, cultural, and economic life are shaped by what is sometime referred to as ‘‘market rationality’’—that is, evaluating the merit of all actions according to what is deemed as valuable, acceptable, or desirable by ‘the market’ ” (Esposito/Perez 2014, 372). Hence, they rely on a meaning which denotes basically capitalism and concerns for efficiency and performance.
For Esposito and Perez neoliberalism advances an image of social reality that normalizes the medicalization of human life. They argue that mental illnesses are often diagnosed and that pharmaceuticals are used to modify people to adjust better to the market reality demanded by neoliberalism. “Many of the pharmaceutical drugs today are not meant to improve health itself but instead designed to enhance the body in such a way that makes one more competitive, attractive, and/or marketable (…).” (ibid., 430).
The authors focus on how “neoliberal thinking” influences the understanding of the individual and mental illnesses. They observe a tendency to treat mental illness as a problem within the individual, disregarding the social realm. Accordingly, this follows the “neoliberal logic” of downplaying the social and treating individuals as self-contained agents. Esposito and Perez call the DSM-III (Diagnostic Statistic Manual of Mental Disorders) a “way to make the human world disappear” as it is dismissing political, cultural, and economic influences (ibid., 422). They argue that instead of looking at the individual’s social circumstances the problem is sought and medicated within the individual.
Cindy Sousa from the Graduate School of Social Work and Social Research of Bryn Mawr College employs in “Political violence and mental health: Effects of neoliberalism and the role of international social work practice” the same line of thought and gives also an example. She looks at the medicalization of political violence and argues that humanitarian trauma relief relies on an individual, biomedical framework, following neoliberal trends (Sousa 2017, 788). By that traumata are de-contextualized and de-historicized, obscuring larger power arrangements and ignoring structures, such as families and communities. This leads to a medicalization of social problems because traumata or depressions are diagnosed by international social workers while the problematic social circumstances are often disregarded (ibid., 794).
Both texts follow a very political approach and are directed against capitalism or neoliberalism. They make an interesting point, but they do not show the same complexity as the text by Levinson and McKinney about medicalization in US-American colleges. Especially the text by Esposito and Perez is rather general and does not support empirical data.
Interface of psychopharmaceuticals and domestic economies
In “Life of the mind” Joao Biehl brings pharmaceuticals in context with economic demands and the partial privatization of the mental health care system. According to Biehl free drug distribution including psychopharmaceuticals is a central component of Brazil’s search for an economic and efficient health care system (2004, 475). This leads to families adjusting the dosages and functioning as proxy-psychiatrists. The families find ways to dictate prescriptions and to adjust the dosages, which often leads to an overmedication. Thus, for Biehl psychopharmaceuticals become central to the story of how personal lives can be made or unmade and unproductive family members can be disposed of (ibid., 489).
Biehl traces back the life of one individual, Catrina, and shows the implications of economic globalization on the individual. As Catrina loses her job and requires care, her family brings her to a “care center”. These centers are private businesses which host the elderly, the mentally ill, the disabled and the homeless in precarious conditions. As the treatment is very insufficient, those care centers are described as final station on the road of poverty where people are left not to get better but to die.
Biehl sees the centers as a way for the family to “get rid of its unwanted and unproductive members” (ibid., 481). As a “defective person” Catrina experiences social death because she is no longer useful for the society and becomes an “ex-human” (ibid., 476). The people in the care centers form according to Biehl a “category of unsound and unproductive individuals who are allowed to die”. Biehl also mentions that the families´ value systems “are remade under the impression of economic pressures” (ibid., 485). He therefore investigates how human value is estimated in a market-oriented society and how the disposal of unproductive persons is mediated via psychopharmaceuticals.
The presented examples show that medicalization can be tied to economic considerations. The definition of an illness is a very political question which also depends on the current economic system and its ideals. Therefore, what is considered as a mental illness changes with time and can be different from culture to culture.
Especially concerning mental health, the question what is considered as abnormal behavior is tied to ideology. As Foucault argued within a dispositive, normal behavior is defined and aberration is sanctioned (1993 , 392). Referring to the economic system this means that persons who cannot function within the economic system get discarded. As mental illnesses are increasingly treated with psychopharmaceuticals, this creates new economic possibilities at the cost of social consequences. Biehl showed that psychotropic drugs play a big role in excluding members of a society permanently as there is no way to undo possible damages caused by overmedication.
Psychopharmaceuticals also open the possibility to enhance oneself and to adapt to academic or economic requirements. Anxieties can be medicalized by categorizing them as disorders which enables the possibility of self-enhancement through medication. Psychological Anthropology can draw attention to these processes and question contemporary scientific developments as cultural products which are tied to the respective political, economic and societal circumstances.
Biehl, Joao. 2004. Life of the mind: The interface of psychopharmaceuticals, domestic economies, and social abandonment. American Ethnologist 31: 475-96.
Boas, Taylo and Jordan Gans-Morse. 2009. Neoliberalism: From New Liberal Philosophy to Anti-Liberal Slogan. Studies in Comparative International Development 44: 137-161.
Conrad, Peter. 1992. Medicalization and Social Control. Annual Review of Sociology 18: 209-32.
Esposito, Luigi and Fernando M. Perez. 2014. Neoliberalism and the Commodification of Mental Health. Humanity & Society 38(4): 414-442.
Foucault, Michel. 1993 . Überwachen und Strafen: Die Geburt des Gefängnisses. Berlin: Suhrkamp.
Levinson, Jack and Kelly A. McKinney. 2013. Consuming an edge: ADHD, stimulant use, and psy culture at the corporate university. Transcultural Psychiatry 50 (3): 371–396.
Sousa, Cindy and David Marshall. 2017. Political violence and mental health: Effects of neoliberalism and the role of international social work practice. International Social Work 60 (4): 787-799.