The Medicalization of Cyberspace

Andy Miah, Emma Rich

• Publisher: Routledge
• Year: 2008
• eBook ISBN: 9781134184415
• Edition: 1
• Topic: Sciences sociales
• Subtopic: Prestation de soins de santé

The entire infrastructure and culture of medicine is being transformed by digital technology, the Internet and mobile devices. Cyberspace is now regularly used to provide medical advice and medication, with great numbers of sufferers immersing themselves within virtual communities. What are the implications of this medicalization of cyberspace for how people make sense of health and identity?

The Medicalization of Cyberspace is the first book to explore the relationship between digital culture and medical sociology. It examines how technology is redefining expectations of and relationships with medical culture, addressing the following questions:

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• How will the rise of digital communities affect traditional notions of medical expertise?

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• What will the medicalization of cyberspace mean in a new era of posthuman enhancements?

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• How should we regard hype and exaggeration about science in the media and how can this encourage public engagement with bioethics?

This book looks at the complex interactions between health, medicalization, cyberculture, the body and identity. It addresses topical issues, such as medical governance, reproductive rights, eating disorders, Web 2.0, and perspectives on posthumanism. It is essential reading for healthcare professionals and social, philosophical and cultural theorists of health.

Part I
Cybermedical discourse

1 Medicalization in cyberspace

To appreciate what is involved in our examination of the medicalization of cyberspace, it is necessary to give a brief overview of some of its characteristics. We explore the various themes evident in the literature on medicalization, as they relate to cyberspace and offer some indication of the theoretical frame for our analysis. Our position is that an exploration of what is happening in online environments can gain from and contribute to wider theories on processes of medicalization. Medicalization is a widely used concept, and, for decades, it has been applied to an expansive range of literature across various fields, perhaps most notably within the sociology of health and illness (Broom and Woodward 1996; Ballard and Elston 2005). Tracing a detailed history of change in the way medicalization has been dealt with politically, academically and medically in the United Kingdom is beyond the scope of this book, though we do register some of the subtle shifts that have occurred in how it has been conceptualized in recent years. To that end, we highlight some of the key features of medicalization and the theoretical discussions that have ensued about the relevancy of this concept in contemporary society. Since our thesis on medicalization of cyberspace has its literary roots in Web studies, medical sociology, the sociology of health, and cyborgology, it provides a developing perspective on the concept of medicalization.

Medicalization and medical sociology

Studies in the area of health and illness, and medicalization, are numerous, and we take a broad view of the field’s scope in this overview. The tendency for more and more problems to be treated as medical issues has long been of interest to sociologists, who have continued to recognize the effects of this process, referred to as medicalization. Since Illich (1975), the observation that medicine has found its way into more and more aspects of everyday life has featured in a range of writings across various disciplines exploring health and illness. Medicalization has become a guiding concept in exploring the processes ‘by which non medical problems become defined and treated as medical problems, usually in terms of illnesses or disorders’ (Conrad 1992:209). Medical language now permeates many everyday activities, including childbirth, sex, reproduction, exercise, drinking, eating, smoking, and pregnancy, such that, as Komesaroff (1995:21) observes, ‘being a bit tired or irritable’, which ‘would most likely have once been put down to working too hard or having to put up with unpleasant social circumstances’, now could provoke someone to ‘see a psychotherapist or a naturopath’.

This process of medicalization has long captured the attention of medical sociologists, who have explored how these features of everyday life come to be viewed as diseases or medical conditions. A number of enduring critiques have been directed at the practices of diagnosing and labelling particular behaviour through medical discourse (see Illich 1975; Zola 1978; Conrad 1992). Zola states the issues directly:

Medicine is becoming a major institution of social control, nudging aside, if not incorporating, the more traditional institutions of religion and law. It is becoming the new repository of truth, the place where absolute and often final judgments are made by supposedly morally neutral and objective experts. And these judgments are made, not in the name of virtue and legitimacy, but in the name of health. Moreover, this is not occurring through the political power physicians hold or can influence, but is largely an insidious and often undramatic phenomenon accomplished by ‘medicalizing’ much of the daily living, by making medicine and the labels ‘healthy’ and ‘ill’ relevant to an ever increasing part of human existence.

(Zola 1998:237)

Moreover, despite critiques (see also Broom and Woodward 1996; Lowenberg and Davis 1994) that highlight the potentially ‘malign social consequences’ (Komesaroff 1995:2) of unwanted medical social control (see Zola 1972), medicalization is still rife within western culture.¹ Depending on which theoretical framework one employs, differing accounts of these processes of social control can be found. Contemporary reflections on medicine and society have, for decades, attempted to theorize this interdependent relationship, as succinctly captured in Komesaroff’s (1995:5) words: ‘The technical outcomes of medicine and its conceptual forms may convey far-reaching social effects; conversely, the social forms find their expression in both medicine’s theoretical structures and its practical techniques.’

Various theorists have also pointed out how the control of populations via medicalization tends to take place not via enforced action, but via the normalization of health behaviours within everyday contexts. Frequently cited in work of this kind, is Foucault’s The Birth of the Clinic (1973), which has illustrated how various medical paradigms throughout history have provided a significant means through which we understand and experience our bodies and subjectivities. Medicalization has a significant impact upon these processes by introducing ‘into previously unproblematic experiences evaluative discourse/meanings, evaluative criteria, which moreover, are presented as socially neutral, technical terms’ (Komesaroff 1995:4). This approach to health care is clearly evident within health promotion strategies oriented towards the prevention of ill health whereby physical activity, alcohol consumption, diet, smoking, and body weight are subjected to a process of medicalization and everyday scrutiny. This kind of ‘surveillance medicine’ (Clarke and Olsen 1999:23) renders an increasing number of everyday activities observable and treatable through medicine. Therefore, it is suggested that medicalization may be shifting medicine from those who are ill, to the lives of healthy people (Miles 1991:183). This decisively impacts on the meanings these activities have for many people, given that

[w]e relate to ourselves and others, individually and collectively, through an ethic and in a form of life that is inextricably associated with medicine in all its incarnations. In this sense, medicine has done much more than define, diagnose and treat disease – it has helped make us the kinds of living creatures that we have become at the start of the 21st Century.

(Rose 2007:701)

Ethically, there are concerns that the practice of medicine is stretching beyond its prescribed role and that this might diminish both the integrity of medicine and, ultimately, patient care. One such case in which these arguments have arisen concerns the medicalization of social behaviours. For example, what was previously considered as deviance might now be defined as medical disorder (see Freidson 1975; Harwood 2006): ‘What has been called crime, lunacy, degeneracy, sin and even poverty is now being called illness, and social policy has been moving toward adopting a perspective appropriate to the imputation of illness’ (Freidson 1975:249). In this process, medical knowledge is constitutive in shifting ‘badness’ to ‘sickness’ (Conrad and Schneider 1980). Recent work by Harwood (2006:7) has provided compelling evidence of the effects of these processes. On the basis of her critique of childhood behaviour disorder discourses, Harwood raises concerns that ‘when a young person is diagnosed as disorderly the diagnosis designates them as psychopathological. It is also likely to signify that much of the child’s behaviour, thoughts, even intentions can be interpreted via the discourses of mental disorder’.

A number of other studies build on the above point by examining the effects of medicalization upon the experiences and subjectivities of individuals. For example, a growing body of work has examined the medical control of women’s bodies (see Miles 1991) through medicalization, and we shall explore these issues further in Chapters 6 and 7. As Clarke and Olsen (1999:3) observe, ‘gendered, cultured, historicised, classed, raced and otherwise situated, women are routinely silenced or erased as actors in the production of health, in both the provision and receipt of health care per se as well as in health politics and policy’. Similarly, Rose (2007:369) argues that ‘some women are more medically made up than others – women more than men, the wealthy differently from the poor, children more than adults, and of course, differently in different countries and regions of the world’. Subsequently, calls have increasingly been made to ‘revision – and thus to retheorize – women, health and healing’ (Clarke and Olsen, 1999:3). While much has been written about how cyberspace is challenging taken-for-granted assumptions about gender and sexuality, little has been revealed about how these concepts are mediated by a medicalization of the body. We explore a number of cases in Chapters 7, 8 and 9 that reveal the tendency for the Internet to provoke core feminist concerns about vulnerability and an ethics of care.

Issues of social control and medical power have, therefore, been central concerns in discussions on medicalization. Moreover, a number of problems arise in relation to the tendency to conflate the terms medicalization and medical control. Broom and Woodward (1996:361) provide a useful distinction, suggesting that medical dominance

is often a component of medicalization but is not identical with it. Medical dominance is evident in the conduct of consultations (when the doctors’ priorities and views dictate what transpires) and in policy making (when the opinions and interests of doctors determine policy decisions) … while medical dominance will often foster medicalization, the two are analytically distinct and may occur independently.

This is an important distinction to take into account when theorizing medicalization, since it affords the conceptual refinement necessary to make sense of the shifting and complex forms of social control that might or might not be present in differing forms of medicalization. Earlier theorizing of this term, while important in identifying the expansion of medicine into everyday lives, has since been subjected to a number of criticisms. Such critique was occasioned, in part, by the rapid expansion of social changes that earlier theories could not so adequately accommodate. Over the past two decades, the concept of medicalization has, thus, been a matter of significant discussion, and continual questions have arisen over its relevance to an increasingly complex society. In 2007, The Lancet published a series of papers (see Metzl and Herzig 2007) from a meeting in New York attended by interdisciplinary scholars ‘seeking to address whether medicalization remains a viable notion in an age dominated by complex and often contradictory interactions between medicine, pharmaceutical companies and culture at large’. This collection of papers exemplifies the concerns that we raise about this concept and its ability to make sense of complex socio-medical phenomena. In particular, they address medicalization in so far as it implies the ‘extension of medical authority beyond a legitimate boundary’ (Rose 2007:701).

Concerns have been voiced about the tendency within theories of medicalization to construct the lay public as passive. As Ballard and Elston (2005:228) observe, ‘earlier accounts of medicalization over-emphasized the medical pro-fession’s imperialistic tendencies and often underplayed the benefits of medicine’. Rose (2007:701) urges caution over the tendency to imply that those who are medicalized are passive, arguing that ‘although drug companies use techniques of modern marketing, they do not seek to dupe an essentially submissive audience’. Rather than being monolithic, these processes might be considered as ‘multifaceted, multicomplex, in some places interlocking and in all cases involving relations of power, privilege, domination and subordination and always located within a specific cultural and his/herstorical context’ (Clarke 1998:47). Therefore, our interest is to consider how cyberspace provides a specific context within which various forms of medicalization may take place.

Consuming medicalization

Another approach to medicalization argues that it should not be attributed only to medical professionals. The role of consumerism, the expansion of health knowledge along with the positioning of ‘pharmaceutical companies in the space once held by doctors as the supposed catalyst of social transformation’ (Metzl and Herzig 2007:697) have all influenced how medicalization takes place. The increased use of pharmaceutical products to combat particular conditions is now a feature of the contemporary health care industry. The Internet offers a unique contribution to these discussions; the emergence of online pharmacies is particularly visible in cyberspace. It has far-reaching consequences and has provoked responses from government, ethicists and health care institutions about the legitimacy of delivering products online and the often widespread condemnation of particular cases. Cyberspace offers a particularly rich context in which to explore some of these complexities of medicalization and commercialization. The worldwide distribution of pharmaceuticals – particularly those that have a non-therapeutic or ‘lifestyle’ function – crystallizes the challenges raised by the redrawing of boundaries that the Internet provokes (Moynihan et al. 2002). In Chapter 7, we connect processes of medicalization with online commerce, drawing upon the example of Viagra, which has been a visible and enduring component of discussions about online pharmacies. A range of conflicts of interest that are latent within the allied medical sciences and professions accompany these concerns. Thus, it is naïve to ignore the interest of pharmaceutical companies in supporting medicalization providing that it leads to the utilization of their products. Also, one must take into account the interests of health care services in seeking the most economically adequate solution to a particular problem, given the limitation of resources.

Other literature has revealed how ‘medicalization is a much more complex, ambiguous, and contested process than the “medicalization thesis” of the 1970s implied’ (Ballard and Elston, 2005:228).² By alluding to a ‘thoroughly medical form of life’ that characterizes contemporary life, Rose (2007:702) calls for a more critical evaluation of these heterogeneous developments. Each of these discussions can be informed by what is taking place online. Indeed, Conrad identifies that it is crucial to understand the ‘impact of the Internet’ (2005:12) in constituting contemporary medicalization debates. Thus, while this book elucidates a process of medicalization of cyberspace, in doing so we suggest that this discussion should inform wider debates about the relevance of the concept of medicalization. Indeed, cyberspace is replete with unusual and emerging medicalized phenomena through which to expand the ethical discussion as to how, why and with what consequences differing forms of medicalization may occur. Therefore, cyberspace can provide an interesting case through which to expand on the concept of medicalization. This is important because certain complexities have been obscured through prior notions of medicalization.

[t]he term medicalization obscures the differences between placing something under the sign of public health (as in the contemporary concern with childhood obesity), placing something under the authority of doctors to prescribe, even though not treating a disease (as in the dispensing of contraceptive pills to regulate normal fertility) and placing something within the field of molecular psychopharmacology (as in the prescription of drugs to alleviate feelings that would once have been aspects of everyday unhappiness).

(Rose 2007:701)

We are also interested in revealing subcultures of medicine on the Internet. We do so through our case studies, which reflect the intricacies and intimacies of medicalized cyberspace. In each of these cases, we explore the negotiations around medicalization taking place across various health/medical discourses.

In sum, despite continual critiques around medicalization, these ideas about the expansion of medicine into everyday life have remained influential, particularly in terms of the governance of medical knowledge. Indeed, public faith in biomedicine continues to remain strong (Lupton 1997). This also says something about the locus of control that governs scientific credibility, which is further disrupted by cyberspace. One of the central themes of our discussion about the medicalization of cyberspace concerns the relationship between ethical and social scientific analyses of medical or pseudo-medical practices that stretch the limits of medicine’s traditional goals. Indeed, the phenomenon of medicalization itself can be characterized as an ethical issue, since it interrogates the legitimacy of professions through which trust and matters of personal privacy are invested. In Chapter 9, we make this ethical context explicit and offer explanations and responses to the positioning of ethics within medicalization work. Importantly, we do not presume that medicalization is inherently a damaging or negative phenomenon – or, at least, that no good comes from this characterization of particular behaviours and lifestyles. Our medicalization of cyberspace extends the work of these more recent explorations of medicalization by applying these ideas to the virtual reality of cyberspace. Our intention is not to give comprehensive ethical accounts of the manifestations of medicalization, but to highlight differing health discourses are made apparent in constructions of (ill) health and the body.

Throughout the text, we reveal how key trends within cybermedicine, such as the commercialization of body parts, patient-led support groups, or cyber-mediated illness stories, are altering both what are understood as the distinctions between biology and artifice (people and computers) and how we understand, construct, challenge or legitimize narratives of health and illness. To this end, our medicalization of cyberspace raises critical issues for bioethics, which might not be so readily expressed in other contexts. We hope that the insights from cyberspace will enhance an understanding of the complexity of the relationships between medical knowledge, discourse, society, identities and experiences of (ill) health. An interest in these issues is not new; however, they are raised here in the context of cyberspace with new dynamics and ethical features and, perhaps, differing impacts on people’s experiences of health and the body. Crucially, the sort of ontological status we give to cyberspace has a bearing on the claims one might infer from health-related encounters. The crucial observation is that the claim that bodies are visible within cyberspace should not lead automatically to the claim that they are inscribed by sociological tropes. Underpinning each of these discussions is an interest in the relationship between medicine, medical knowledge and social context and values.

2 The cyborg body

In this chapter, we explore the theoretical parameters of cybermedicalization by considering the implications of body studies in digital culture. This analysis informs Part II, where we provide detailed cases of cybermedical bodies and develop the claim that the onlin...

Table of contents

• Cover page
• Title Page
• Copyright Page
• Preface
• Introduction: Medicine in society
• PART I Cybermedical discourse
• PART II Cybermedical bodies
• Conclusion: After-cyborgs or artificial life
• Afterword
• Notes
• Bibliography