The Idea of Medicalization: An Anthropological Perspective

THE IDEA OF MEDICALIZATION: AN ANTHROPOLOGICAL PERSPECTIVE HORACIO FABREGAJR.* Introduction The idea that there is taking place a medicalization in contemporary society seems to imply that attitudes and concerns which properly should be directed at "medical" problems are being misdirected to phenomena or problems of a different character altogether. Individuals who speak of medicalization seem to have in mind a more or less normative picture of society and judge that particular types of problems can be clearly bounded, labeled unproblematically, and dealt with through delimitable institutions of control. Such individuals often follow a historical and comparative point of view and have in mind a previous era when the domain of disease-illness and medical care was more "correctly" interpreted . The idea of medicalization is not widely used by anthropologists who study medical phenomena in preliterate and literate societies. All anthropologists—especially biologically oriented ones—would agree that the concrete physical changes in the body which we see today and link to disease are ubiquitous and recurring and have been the lot of mankind throughout the period of human evolution. Moreover, all anthropologists ^—especially culturally oriented ones—would support the idea that peoples of the world differ greatly in the way they define diseaseillness and go about dealing with the problems linked to this. The latter type of anthropologist would probably challenge the assumption that there is a distinct and more or less correct view of disease-illness and medical care, an assumption central to historians, sociologists, and social critics who endorse the idea of medicalization [1, 2]. In this paper the idea of medicalization is analyzed from a general anthropological point of view. The way in which medical problems are handled in preliterate societies is given principal attention, though mate- *Professor of psychiatry and anthropology, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, Pennsylvania 15261.© 1980 by The University of Chicago. 0031-5982/81/2401-0218$01.00 Perspectives in Biology and Medicine ¦ Autumn 1980 ] 129 rial from the social history of Western medicine is included. Relations between medicine and society are looked at culturally and also from an evolutionary point of view. This type of approach should allow one to look at the problem of "medicalization" in a broader way. Illness and Disease in a General Anthropological Frame ofReference Things we describe as "illness" and "disease" are universal happenings in social groups. AU peoples, it seems, experience disease and illness and want to be rid of them. Disease and illness are also a universal biologic phenomenon. The conditions for disease-illness are prescribed by the synthetic theory of evolution. This is to say that key concepts of evolutionary biology, such as genetic variability, environment, adaptation, and natural selection, are sufficient to explain occurrences of illness and disease. In a strict biological evolutionary sense, disease-illness is a factor which influences the operation of natural selection. It is one of the sources of adaptive variability which determines which organisms are selected; and if genetic factors underlie the disease-illness (in evolutionary theory, the expression of a poor organism-environment fit), these will be underrepresented in future generations [3]. Anthropologists emphasize the social dimension of an individual's medical problem [4]. They often use the term "illness" in a special way to emphasize a disvalued state or condition of the individual considered as a whole being. By illness they meant something manifested concretely in behavior adaptation, and they draw a distinction between this and the underlying disorder or disease process, which is physical. Illness is thus construed as a discontinuity in the life arc of a person involving an impairment in function and hence a deviation. In all groups, a state of illness is associated with a relative failure to perform basic expected tasks. The individual acknowledges—implicitly or explicitly—his "ill" state, and he shows this in behavior overtly, covertly, and/or symbolically in words. The social group usually validates or certifies a claim of illness. This is a fairly general observation, though it is not true in our culture. Our system of medicine allows positing that someone who claims illness is really not physically diseased. A malingerer, for example, is a person claiming illness who is judged as not...