Medicalization
Medicalization is “the process by which ‘non-medical’ (or ‘life’ or ‘human’) problems become understood and treated as ‘medical’ problems”(Conrad, 2007). Eugenics is intrinsically linked to a deficiency, typically relying on a medical understanding of the genetic and non-genetic make-up of the body and its physical, cognitive, mental and neuro-abilities. People labelled as impaired due to not fitting the species-typical ability norm were (and still are) one main target for negative eugenic practices, such as sterilization. The elimination of the ‘impaired’ fetus after detection through prenatal testing, and the deselection against embryos that are identified as impaired after pre-implantation diagnostic, are two other negative eugenic practices that depend on medicalization.
Questioning the medicalization of ability differences A lively debate exists around the labelling of ability differences as impaired. Indeed, many people labelled as impaired question that labelling. Deaf Culture (Blume, 2010; Hladek, 2002; Wolbring, 2011; Zeng, 1995), and neurodiversity (Jaarsma & Welin, 2012; Jurecic, 2007; Kapp, Gillespie-Lynch, Sherman, & Hutman, 2013; Trivedi, 2005) discourses are just two examples where the people labelled as impaired (hearing impaired and neuro-ability impaired) question that medicalized deficiency label. One of the main pillars of inquiry in disability studies is to question the labelling of people seen to have abilities below the species-typical norm as being impaired.
Medicalization of the species-typical healthy Medicalization of the healthy (Kelleher & Wilson, 2005) is a dynamic whereby perfectly healthy persons are made to feel badly about their appearances or functioning. It sells to healthy people the idea that they are sick; “disease-mongering” is a term some people use (Editor, 2002c; Ferriman, 2002; Moynihan, Heath, & Henry, 2002; Tiner, 2002). In 1999, Americans saw an average of nine prescription drug advertisements a day on television, portraying the dual message of a pill for every ill and “an ill for every pill” (Editor, 2002a). Day quotes the Royal College of General Practitioners as accusing drug companies of “disease-mongering” in order to boost sales. (Day, 2004). “Once the need has been established and created, then the product can be introduced to satisfy that need/desire,” states Harry Cook (Burton & Rowell, 2003). Since the Food and Drug Administration (FDA) approved direct to consumer advertisement in 1997, US retail drug costs have increased from $20.8 billion to $131.9 billion from 1999 to 2000, according to the US National Institutes of Health Care Management (Sharratt, 2003). Sharratt has listed the top 10 direct-to-consumer drugs by sales for 2003 in the USA (Sharratt, 2003). The reality of medicalization is acknowledged by many among them the Canadian National Forum on Health (Canada 1997, Editor 2002b). A recent issue of the Seattle Times mentions “75 percent of the adult U.S. population as diseased”(Kelleher & Wilson, 2005).
According to American Medical Association Trustee William E. Jacott, MD, physicians are increasingly feeling pressured by patients to prescribe a drug that they have seen advertised (Online, 1998). The American Society of Plastic Surgeons estimates that in 2004, about 260,000 women received breast augmentation for cosmetic purposes only, and about 60,000 women received augmentation after undergoing a mastectomy (Hwang, 2005).
The medicalization of beauty as health is a fruitful field. The statement by the American Society of Plastic and Reconstructive Surgeons to the FDA in defense of breast implants concisely summarizes the argument by which breast augmentation has become medicalized:
The female breast that does not achieve normal or adequate development. . . [is] really a disease which in most patients results in feelings of inadequacy, lack of self-confidence, distortion of body image and a total lack of well-being due to a lack of self-perceived femininity (Mellican, 1995).
Medicalization and the enhancement model of health "'I believe in transhumanism': once there are enough people who can truly say that, the human species will be on the threshold of a new kind of existence, as different from ours as ours is from that of Peking man. It will at last be consciously fulfilling its real destiny." Julian Huxley, First Director-General of UNESCO(Huxley, 1957)
The enhancement model of health sees every non-enhanced human body as defective and in need of improvement beyond the species-typical boundaries: every non-enhanced human being is seen as impaired. Every human, no matter how medically healthy in the species-typical sense, is defined as limited, defective, impaired, and in need of constant improvement made possible by new technologies—a little bit like the constant software upgrades we do on our computers). Here “medically healthy”, at a time, means having obtained maximum human enhancement of one’s abilities, functions, and body structure beyond species- typical boundaries (Wolbring, 2005, 2010). The enhancement model of health moves the dynamic of medicalization toward perceiving the species-typical body in need of improvement period. If species-typical is a diseased state, one can justify the field of enhancement medicine (Wolbring, 2005) where one employs genetic (somatic enhancement, germline enhancement, synthetic biology) and non-genetic (cyborgization) interventions as therapies.
Conclusion: the importance of narrative People labelled as impaired because they are seen as not fitting the species-typical ability norm have long questioned the narrative that leads to that labelling and its disabling consequences, including negative eugenic actions. However, the problem of how we decide that someone is impaired and the disabling consequences they experiences is not just an issue for such people. Medicalization and the disablement that comes with it also increasingly covers those seen so far as healthy. It is of importance for all that we monitor the medicalization dynamic and outline its consequences.
-Gregor Wolbring
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