Medicalisation in the 21st century: introduction.

What is medicalisation? What are its causes and eff ects? Who benefi ts from medicalisation, and who is harmed? What, if anything, should be done about it? Answers to these questions would have seemed quite obvious in the 1970s, when the term entered academic and medical publications: medicalisation, the expansion of medical authority into the domains of everyday existence, was promoted by doctors and was therefore a force to be rejected in the name of specifi c kinds of liberation. Ivan Illich’s 1975 book, Limits to medicine: medical nemesis, was the most infl uential early example of this usage of the term medicalisation. Illich, a philosopher, argued that the medical establishment posed a “threat to health” through the production of clinical, social, and cultural “iatrogenesis”. For Illich, Western medicine’s notion of issues of healing, ageing, and dying as medical illnesses eff ectively “medicalised” human life, rendering individuals and societies less able to deal with these “natural” processes. Illich’s assessment of professional medicine, and particularly his use of the term medicalisation, quickly caught on, as critiques of the expansive categories of illness and health appeared throughout a vast array of professional literatures throughout the 1970s and 1980s. 30 years on, the defi nition of medicalisation is more complicated, if for no other reason than because the term is used so widely: a Google search for “medicalisation” in 2006 yields more than 358 000 hits. Many contemporary critics position pharmaceutical companies in the space once held by doctors as the supposed catalysts of social transformation. Titles such as The making of a disease or Sex, drugs, and marketing critique the pharmaceutical industry for shunting everyday problems into the domain of professional biomedicine. At the same time, to suggest that society simply reject drugs or drug companies in much the same ways Illich suggested it “liberate” itself from the medical system is implausible. The same drugs that treat deviances from societal norms also help many people live their lives. Even scholars who critique the societal implications of brand-name drugs generally remain open to these drugs’ curative eff ects—a far cry from earlier calls for a revolution against the biomedical establishment. The physician’s role in this present-day notion of medicalisation is similarly complex. On one hand, the doctor remains an authority fi gure who prescribes pharmaceuticals to patients. Whereas on the other, in the USA at least, ubiquitous consumer-directed advertisements instruct patients to ask for particular drugs by name, thereby creating a conversation between consumer and drug company that threatens to cut the doctor out of the loop. The role of patients in this economy has also changed. Once regarded as passive victims of medicalisation, patients can now occupy active positions as advocates, consumers, or even agents of change. In June, 2005, an interdisciplinary group of scholars gathered in New York City, USA to discuss the clinical, philosophical, and political implications of medical isation. The group’s central question was whether, in the industrialised world, medicalisation remains a viable notion in an age dominated by complex and often contradictory interactions between medicine, pharmaceutical companies, and culture at large. Participants represented a variety of disciplines, including psychiatry, sociology, anthropology, history, critical race theory, and gender studies. As such, topics ranged from the economics of medicalisation to the creation and perpetuation of medicalised forms of identity and citizenship. The next fi ve papers in this series are those that were presented at the meeting in New York.