Medicalization Menace? A New Culture War

The NYT’s Well blogger Tara Parker-Pope notes the new pride many of those with ADHD feel in the wake of Michael Phelps’s success:

[T]he Olympic superstar . . . is emerging as an inspirational role model among parents and children whose lives are affected by attention problems. . . . Children with the disorder typically have trouble sitting still and paying attention. But they may also have boundless energy and a laserlike focus on favorite things. . . .

Like Adrienne Rich’s Marie Curie, or Kay Redfield Jamison’s geniuses, these “disordered” individuals are simultaneously sufferers and successes.

They’re also part of a larger cultural movement questioning the medicalization of various “deviant” personalities. Rather than treat boys for ADHD, some Norwegian schools just start them in school later. Allan V. Horwitz worries that “normal sadness” is being rendered socially unacceptable on account of pharmaceutical fixes:

Consumption of antidepressants has soared since 1990. Roughly 10% of women and 4% of men in the United States take antidepressant medication at any time. . . .The blurring of the distinction between normal intense sadness and depressive disorder has arguably had some salutary effects. For example, it has reduced the stigma of depression and created a cultural climate that is more accepting of seeking treatment for mental illness. Many people with normal sadness might benefit from medication that ameliorates their symptoms. However, the usefulness of medication for normal sadness, and especially the trade-off between symptom reduction and adverse effects, has not been carefully studied—partly because the necessary distinctions do not exist within the current diagnostic system.

The decontextualized definition of MDD, however, has had substantial costs. Since 1980, an enormous “medicalization” of unhappiness has occurred. Life’s ills—whether a failure to attain an expected promotion, ongoing conflict with a spouse, or overwhelming distress from coping with competing family and work demands—are too often treated as mental disorders based on the report of a few symptoms of sadness. The medicalization of social life triggered an immense rise in the consumption of antidepressants. The efficacy of these medications for the treatment of normal sadness is often overstated, and their potential to cause harmful effects has sometimes been underestimated.

Medicalization may also be contributing to cyberchondria. We should not ignore the market forces contributing to the process, as David Healy notes:

One consequence of the recent “biological” turn is that psychiatrists increasingly fail to appreciate the dynamic of their relationships with their patients. There is a growing split between pharmacotherapy and psychotherapy that is most evident in North American psychiatry. Actual time with patient is shrinking rapidly. Psychiatrists now commonly prescribe medications after only a brief encounter with the patient, and with only occasional follow-ups. . . .Prescribing antidepressants has become as antiseptic a therapeutic encounter as giving an antibiotic.

The antibiotic analogy is apt. As I argued last year, while the internal experience of equilibrium and happiness is often intrinsically good, the external display of such affect can be a positional good. We see increasing reports of people in competitive jobs taking pills or shots to maintain an upbeat affect and appearance. The competition to seem upbeat could become an arms race–individually rational, but collectively self-defeating. Antibiotic use can follow a similar pattern–while any individual wants to be on the safe side and take the drug, widespread overuse leads to resistance.

One more example of medicalization spawning collectively self-defeating behavior is cosmetic surgery. As Anthony Elliott’s brilliant new book on the topic shows, “[T]he flipside of today’s reinvention craze is fear of personal disposability” (145):

My argument is that the new economy spawned by globalization intrudes traumatically in the emotional lives of people – with many scrambling to adjust to today’s routine corporate redundancies. (…) [C]orporate layoffs, downsizings and offshorings are affecting people’s sense of identity, life and work. (…) Many have reacted to this sense of social dislocation and economic insecurity – what I term today’s pervasive sense of ambient fear – by turning to forms of extreme reinvention in general and cosmetic surgical culture in particular. Many are calculating that a freshly purchased face-lift or suctioning of fat through liposuction is the best route to improved lives, careers and relationships. (9)

As Charles Taylor argued in his great essay “What’s Wrong With Negative Liberty,” we should always interrogate the conditions under which choices are made. The enhancements achieved via the medicalization of hyperactivity, sadness, and plain looks are contestable. As market-driven pressures for conformity ratchet up, we may see new identity politics developing around introversion, hyperactivity, sadness, heaviness, and plainness.

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