I found the visualization below to be a very striking illustration of the concept of medicalization:

As you can see, the growth of the DSM perfectly illustrates the range of behaviors that come to be labeled as pathological, and therefore, under the normative purview of the medical profession.

This is also further illustrated by the rise of diagnosing conditions (which is, of course, connected to what is in the DSM):

“The diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) is on the rise in American children, with an estimated 2 million more kids receiving a diagnosis of ADHD and 1 million more taking medication for ADHD in 2011 than there were in 2003, according to new data released by the U.S. Centers for Disease Control.

In a 2011 national survey of more than 95,000 U.S. households, the CDC found that 11 percent of children between the ages of 4 and 17 — or 6.4 million children nationwide — had received a diagnosis of ADHD, a disorder characterized by hyperactivity, trouble controlling impulsive behaviors and difficulty paying attention.

Among those children who had been diagnosed with ADHD, 83 percent were considered to currently have the disorder, or 8.8 percent of all kids nationwide. And among the children who currently have the disorder, 69 percent are taking medication to treat it — which comes out to 6.1 percent, or 3.5 million kids nationwide, the researchers said in the CDC report released Friday.”

And one can see the correlation between power dynamics and social control:

“Overall, the prevalence of childhood ADHD increased by 42 percent between the years 2003 and 2011, and the frequency of children taking medication for ADHD increased by 28 percent between 2007 and 2011.

“This suggests an increasing burden of ADHD on the U.S. health care system,” the authors of the study wrote. “Efforts to further understand ADHD diagnostic and treatment plans are warranted.”

The researchers did not indicate why ADHD among children has increased, but offered a few potential reasons: significantly, an increase in parental reports of their kids’ ADHD, or “better detection of underlying ADHD, due to increased health education and awareness efforts,” the authors wrote.

The researchers noted that the “prevalence of ADHD medication use also increased despite an overall downward trend in pediatric medication prescriptions,” and that the study’s data suggest that “the impact of ADHD may be increasing.”

The demographic groups most affected by ADA included boys — 15.1 percent of them had ADHD, versus just 6.7 percent of girls. Nearly one in five high school boys and one in 11 high school girls were diagnosed with the disorder.

In addition, children who were white, who lived in the Midwest, and kids whose families lived above 100 percent of the poverty line were more likely to be diagnosed with ADHD.

In terms of regional trends, children living in the West were least likely to receive a diagnosis of ADHD; state-based estimates of ADHD frequency ranged from 4.2 percent of kids in Nevada and 5.9 percent in California to 14.6 percent of children in Arkansas and 14.8 percent in Kentucky.”

It is amazing that there is no questioning whatsoever of the validity of the label for this condition. It is just accepted as an objective medical diagnosis, and therefore, the only question is how to treat it. The fact that the explanation for the increase is roughly limited to greater reporting rather than greater social awareness that a bundle of behavioral markers have been given a medical label and medical treatment options. There is also no real questioning of the demographics: boys, white, non-poor, that is, people who have access to the medical profession. Boys, of course, are more subject to behavior sanctioning in the school system, that is not new. But instead of being given detention, they get a medical diagnosis.

On this topic, the Very Public Sociologist, PhilBC, does a good job of unpacking the social construction of disorders that are currently in fashion:

“Why have Autism and Asperger’s only recently been codified as a social concern? It could part be media curiosity, part the growth and spread of the internet, and part visibility attained by the disabled rights movement. The inescapable trope of the autistic genius might have a role, too.

But I think something deeper could be going on, something to do with structural shifts in the advanced capitalist countries. Short-sightedness and Dyslexia were not social concerns prior to industrial capitalism. The point came when the demands of capital required something more than able bodies to work in its dark, satanic mills – it needed basic education to record and pass on information at all levels. Since then, particularly over the last 30 years, manufacturing has taken a battering. The old industries have fallen back and in its place are what we used to call tertiary industry: the service sector. This sector, from retail to investment banking, from call centres to consultancies, all absolutely depend on social relationships. Of course, thus it ever was. But now is different – the direction of travel clearly is capitalism’s growing dependence on the wealth that can be mined from relationships. Hence the massive values of social media firms who’ve yet to make a single penny of profit. Hence the obligatory ‘person spec’ placed alongside graduate job adverts. Hence the growth of consultancies selling team-building experiences. Hence the concern with Autism and Asperger’s.

For Autistic and Asperger’s people, the economic shift to service finds them singled out as disabled individuals. In front of the new emphasis on relationships, on the complexity of social cues and the (personal and commercial) premiums on networks; they are the newly dis-abled. And this is a very recent shift.”

But PhilBC makes another connection that is also important: what gets considered a crisis and how it is dealt with within the current social arrangements:

“There is an alternative explanation, but again related to changes in political economy. We know Britain is in the midst of a mental health epidemic. One-in-four of us suffer with a mental health problem during the course of a year. Thankfully, the stigma attached to mental health is beginning to lift and it is starting to be talked about. Partly, this is because these problems are so widespread. Why should we be surprised that more insecure and pressured work situations lead to stress, anxiety and illness? That low wages, crushing debts and attacks on social security screw people up? It is reasonable to assume that more job security, more stability would have the effect of decreasing incidences of mental ill-health. But also, with capital’s emphasis on relationship and service, any health problems impacting on its capacity to do business on that basis is bad news. It’s a concern. A social problem. So, is it possible that the relatively recent problematisation of Autism and Asperger’s is a subset of a wider recognition of a crisis around mental health?”

Emphasis mine.

But, of course, whenever something is defined as a problem, the way to deal with said problem has to be framed within the parameters of dominant ideologies and practices. And so, when mental problems are seen to be increasing because of precarious (or liquid, as Bauman would say) social conditions, then, the remedies are not to be found in changing the social conditions. No, under the norms of advanced capitalism, remedies have to be individualized, medicalized, and fit within corporate power.

Hence, this:

Doctors across Europe are warning that the soaring use of antidepressants is down to growing pressure to “medicalise” unhappiness, complaining that a lack of time and meagre availability of other therapies meant that physicians reach for the prescription pad far too often.

In response to a questionnaire devised by the Guardian and five leading European newspapers, the vast majority of almost 100 European doctors and psychiatrists who replied said there was a “prescribing culture” in their country because other help for people with depression was inadequate.

Many of the doctors – from the UK, France, ItalyGermanySpain, Luxembourg, Belgium and the Netherlands – said they believed antidepressants were an effective treatment for cases of severe depression. But dozens expressed frustration that limited time and even more limited resources mean that they often feel pressured to prescribe pills in less-urgent cases.

We are medicalising common situations: conflict, separation and the vicissitudes of life,” said Gladys Mujica Lezcano, a Barcelona-based hospital doctor.

“They are prescribed much too easily,” added Alain Vallée, a psychiatrist from Nantes in France. “If you take an antidepressant and it doesn’t work, you don’t think it’s because you might not be depressed, but that you need to take a stronger one.””

And if the vicissitudes of life widen, as socioeconomic conditions deteriorate, and insecurity increases, then, individually-prescribed medical remedies are the proper solution and recourse.

This is especially interesting when one considers current discourse on health care: rising costs, over use, etc. So, a lot more behaviors have been medicalized, requiring pharmaceutical treatments prescribed individually (something that is often presented as a freedom: patient rights, etc.), but at the same time, then rising costs will demand potential cuts in health benefits (see: Medicare upcoming “crisis”). Double whammy.

A last piece of the overall puzzle has to do with the fact that US physicians tend to make more money than their counterparts in other high-income countries, but are also fewer in number (see the data at this post by Echidne):

Doc pay

Echidne argues this has to do with market controls: access to the profession is guarded by gatekeepers, whether medical schools or physicians’ professional associations. And there may be very good reasons for this (medical services are not like other consumer markets). And such greater control turns into greater social power not just in who can join the club, but regarding what is considered the prerogative of the medical profession. Which gets us back to my initial visualization on the DSM.

Strict controls over access and numbers in the profession + expanded territory = power ← this goes both ways, of course, in mutually reinforcing dynamics. And as more socially-based pathologies occur, they “naturally” come under the purview of the currently powerful group dedicated to dealing with pathology in general (as opposed to priests, 300 years ago in Europe, for instance).

The risk society is a medicalized society.

By SocProf.

A few weeks back, the Economist’s Daily Chart feature had this highly informative chart:

Compared to other rich countries, the United States has a whole bunch of health and health care outcomes that are out of whack with the rest of high-income countries especially considering the higher % of the GDP dedicated to health spending.

Yesterday, the Washington Post had a series of graphs on the same topic, zeroing on higher prices for procedures and medications. Here are a few.

Cost differential for a regular doctor visit:

Hip replacement:

Cost per hospital day:

MRI:

Medication: Nasonex.

And last but not least:

So, higher costs across the board, but poorer outcomes in the end.

As always, the essential sociological question: who benefits? (It’s not a hard one)

By SocProf.

I know this is Todd’s territory here but I found this article on the Portuguese approach to drug policy quite interesting:

“One gram of heroin, two grams of cocaine, 25 grams of marijuana leaves or five grams of hashish: These are the drug quantities one can legally purchase and possess in Portugal, carrying them through the streets of Lisbon in a pants pocket, say, without fear of repercussion. MDMA — the active ingredient in ecstasy — and amphetamines — including speed and meth — can also be possessed in amounts up to one gram. That’s roughly enough of each of these drugs to last 10 days.

(…)

“The police still search people for drugs,” Goulão points out. Hashish, cocaine, ecstasy — Portuguese police still seize and destroy all these substances.

Before doing so, though, they first weigh the drugs and consult the official table with the list of 10-day limits. Anyone possessing drugs in excess of these amounts is treated as a dealer and charged in court. Anyone with less than the limit is told to report to a body known as a “warning commission on drug addiction” within the next 72 hours.”

In other words, decriminalization. This was passed in 2000, so, they have had this policy in place for about 12 years. Enough time to have some evaluation.

So, what are the results?

“The data show, among other things, that the number of adults in Portugal who have at some point taken illegal drugs is rising. At the same time, though, the number of teenagers who have at some point taken illegal drugs is falling. The number of drug addicts who have undergone rehab has also increased dramatically, while the number of drug addicts who have become infected with HIV has fallen significantly. What, though, do these numbers mean? With what exactly can they be compared? There isn’t a great deal of data from before the experiment began. And, for example, the number of adults who have tried illegal drugs at some point in their lives is increasing in most other countries throughout Europe as well.”

Not bad. The whole idea is to treat addiction as a disease and not a crime.

What is interesting, from the article, is that the opposition to this law and policies is a based not on the possibility that it might actually work but on the moral idea that people should NOT want drugs and should be punished for wanting to use. It is a puritan argument and that is as far as it goes. There is nothing else:

“”It’s important that we prevent people from buying drugs, and taking drugs, using every method at our disposal,” says Manuel Pinto Coelho, 64, the last great opponent of Goulão’s experiment. Pinto Coelho wants his country to return to normalcy, in the form of the tough war on drugs that much of the rest of the world conducts.”

Of course, it is a war on drugs that does accomplish much except filling up prisons and keeping criminal justice systems overwhelmed with low hanging fruits. Perhaps we should have a Gans-type “functions of drug policy” list.

Again, it is not policy, it is moral standing irrespective of the results. It is interesting to have failing policies defined as “normalcy”.