Ethical issues in moral and social enhancement

5.2.
What is medicalization? 
5.2.1. Medicalization – early sociological approaches
For the last thirty or forty years, sociologists have used the term 
medicalization 
to 
refer to the process by which ‘non-medical’ (or ‘life’ or ‘human’) problems become 
understood and treated as ‘medical’ problems (Conrad, 2007, pp. 3-4). While early 
critics of medicalization focused on psychiatry (Szasz, 1970) or a more general 
notion of medical imperialism (Illich, 1975), sociologists began to examine the 
processes involved in the expansion of medicine’s realm (Freidson, 1970; Zola, 
1972). As sociological studies on medicalization accumulated (see Conrad, 1992; 
2000) it became clear that medicalization went far beyond psychiatry and was not 
always the product of medical imperialism, but had arisen at the intersection of 
complex social forces. According to Conrad, the research then focused on the 
definitional issue: defining a problem in medical terms, usually as an illness or 
disorder or using a medical intervention to treat it. Many early sociological studies 
took a social constructionist approach to those problems, with the focus on the 
construction of new medical categories, an increasingly medicalized approach to 
conditions such as ADHD, menopause, alcoholism and PTSD and the resulting 
expansion of medical jurisdiction (see: Conrad, 1992). 
Conrad suggests three broad areas of focus found in the sociological studies of 
medicalization in the 1970s and 1980s that aimed at explaining the causes of 
medicalization: the power and authority of the medical profession, activities of 
social movements and the influence of professional or organisational actors. Firstly, 
medical professionals sometimes were at the center of the move towards 
medicalization, such as in the cases of hyperactivity, menopause, child abuse and 

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child-birth, among others. Physician involvement was considered through the lens 
of concepts such as professional dominance, physician entrepreneurs or medical 
colonisation. Secondly, medicalization was thought to be fuelled by the activities of 
social movements and interest groups, which argued, campaigned and lobbied for a 
medical definition for a problem or to promote the veracity of a medical diagnosis. 
A clear example is alcoholism, with the involvement of Alcoholics Anonymous and 
a wider ‘alcoholism movement,’ while physicians remained mostly at the backstage 
of the events. Social movements were also critical in the medicalization of PTSD 
(Scott, 1990) and Alzheimer's disease (Fox, 1989), although some efforts by activist 
groups were less successful, such as the case of multiple chemical sensitivity 
disorder (Kroll-Smith and Floyd, 1997). Third, organisational or professional 
agents sometimes played a prominent part in medicalization. The examples include 
the rise of obstetricians and the demise of midwives in some countries (Wertz and 
Wertz, 1989) and the rise of behavioural paediatrics (Pawluch, 1983; Halpern, 
1990). Although in early studies of medicalization, different stakeholders were also 
mentioned (such as the role played by pharmaceutical innovation and marketing in 
hormone replacement therapy), the causal role of health care funding and 
pharmaceutical companies was considered to be of secondary importance.