Medicalization

The Power to Define Sickness

The concept of medicalization was introduced during the second half of the 20th century when Americans were registering rising distrust in and disillusionment with the values being expounded by the leaders of most social institutions. Hence, the times were conducive to rejecting a socially defined view of deviance in favor of a medical-based perspective. Critics argued, and many observers agreed, that the prerogative to determine what is and what is not a medical problem gives physicians tremendous power. The question of whether this is more socially beneficial or detrimental remains unsettled.

Talcott Parsons (1902–1979), an American, Harvard University sociologist, is credited with initiating discussion of the vital social role played by physicians in differentiating between true sickness and malingering. He based this proposition on the premise that social stability and continuity require that all members of society fulfill their respective social roles. Because the “sick” role offers the benefit of excusing a person from normal responsibilities, it is important to ensure that people do not take inappropriate advantage. By identifying what constitutes real illness, physicians are in a position to grant patients a temporary exemption from their normal role responsibilities. By labeling symptoms as true illness, physicians are granting the patient a period of “legitimated deviance.” Physicians then go on to restore the sick person to full health so that he or she can carry out the normal role expectations. Because physicians are willing to accept this weighty burden, Parsons maintained that they should be generously rewarded.

Parsons's model of the sick role depicted recovery from acute illness as the only acceptable resolution to a period of legitimated deviance. Detractors pointed out that this portrayal meant that those who did not or could not get well were doomed to being permanently labeled as deviants.

A number of observers have made the point that having the power to determine whether the symptoms patients present with are, in fact, indicative of a disease gives physicians undue power to act as moral arbiters. From time to time, the discovery of a newly identified disease reinvigorates the charge that physicians have too much power and that patients' complaints are too often dismissed as illegitimate. The discovery of Lyme disease provides a vivid illustration. According to media reports, it was only through the efforts of one courageous woman that the disease was finally identified. Because her symptoms were so common (i.e., headaches, body rashes, and flu-like conditions), she was diagnosed with various conditions from poison ivy to hysteria by the many physicians she visited. The media reported that the physicians denied the existence of this particular patient's disease because it did not fit a recognized diagnostic label. Not only was she repeatedly told that she was a hypochondriac, she was denied the benefits of the sick role as well as treatment.

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