Medicalization Through the Re-Definition of Problems and Solutions


Michael Slinger, University of Ottawa

In this paper, I analyze how the practice of psychotherapy medicalizes previously non-medical topics through both the re-definition of problems and the re-definition of solutions. I do not seek to ascertain whether a given problem or practice is “truly” medical and should be managed by health care professionals. Instead, through this paper, I analyze the process by which “problems” become understood as mental illnesses and “solutions” as psychotherapeutic interventions. Understanding how psychotherapy proliferates medical understandings and the jurisdiction of the “psy” professions is key given the increasing popularity of this treatment modality, with recent U.S. data estimating that roughly 10% of the population received psychotherapy within the past year. Using a grounded theory approach, I conducted 15 semi-structured interviews with two groups of practitioners in Ontario: clinical psychologists—who have completed an accredited graduate program culminating in a PhD dissertation and year-long clinical internship—and MD psychotherapists—who have complete medical school, residency, and a year-long fellowship in medical psychotherapy. I examined the various interventions and therapeutic techniques these practitioners employ to produce changes in the patient’s condition, exploring the medio-professional language and framings practitioners use to structure their everyday clinical activities. I argue that practitioners facilitate medicalization through an ambivalent attitude towards the Diagnostic and Statistical Manual’s (DSM-5-TR) understanding of mental illness. Despite consistently using DSM diagnostic labels, practitioners prefer to view mental illness as a biopsychosocial feedback loop—an active, multifaceted, self-maintaining process that incorporates the patient’s brain-body as well as their current and past social environments. Here, definitions of “illness” remain loosely coupled to the official language of the mental health professions, allowing practitioners to medicalize problems outside of the supposed scope of the DSM. I further argue that practitioners spread medical understandings through an often-overlooked form of medicalization: medicalization via the re-definition of solutions. Through this process, an intervention that previously was not seen as medical in nature is transformed into a “medical intervention”—i.e., a treatment or therapy. I develop medicalization through the re-definition of solutions by contrasting it against existing approaches that have predominately focused on the re-definition of problems, e.g., how deviance, badness, and “problems in living” come to be understood through the label of “illness”. I argue that just as pharmaceuticalization and traditional medicalization theory question how “medical diseases” are socially constructed, we can also examine how the “medical nature” of interventions is constructed by health care professionals. Applying this lens to the practice of psychotherapy, I propose that practitioners ascribe a medical, healing function to social support and emotion management techniques, bringing these previously non-medical emotional interventions under the purview of mental health professionals. I detail the parallels between lay and professional emotion management, connecting psychotherapy’s medicalization of emotion management to the broader medicalization of emotions. In sum, focusing on the re-definition of problems limits the applicability of medicalization theory by overlooking how medicalization can shape our understanding of both illnesses and healing practices. Medicalization through the re-definition of solutions must be examined alongside medicalization through the re-definition of problems to fully gauge the nature and extent of this process.

The paper based on this presentation has received the Sociology of Culture Research Cluster's Best Student Paper Award.

This paper will be presented at the following session: