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Soc (2008) 45:382–384
DOI 10.1007/s12115-008-9100-x
BOOK REVIEW
Peter Conrad, The Medicalization of Society:
On the Transformation of Human Conditions
into Treatable Disorders
Johns Hopkins Press, 2007. 224 pp. $20.00. ISBN-10: 080188585X;
ISBN-13: 978-0801885853
Robert Dingwall
Published online: 11 June 2008
#
Springer Science + Business Media, LLC 2008
Although the Oxford English Dictionary does not give
Peter Conrad the credit for inventing the term
‘medical-
ization’—their first reported usage is in the New England
Journal of Medicine in 1970—it has been indelibly
associated with him since the publication of his doctoral
research on hyperactive children in the mid-1970s. Over the
succeeding years, however, the concept has taken on a life
of its own as other writers have appropriated the idea and
applied it to a wide range of problems and domains. In the
process, it has lost a great deal of the precision that Conrad
sought to achieve. The Medicalization of Society reviews
the evolution of the term and seeks both to clarify its
refinement and to note the ways in which its referent has
changed over the last 30 years.
As Conrad himself acknowledges, the basic idea is not
new. It is a strong theme in Michel Foucault’s work: indeed
the translator of Birth of the Clinic uses the word in 1966,
4 years before the OED’s first recognition of its existence.
We might even cast back to the German poet JW Goethe,
writing in 1787:
“Speaking
for myself, I too believe that
humanity will win in the long run; I am only afraid that at
the same time the world will have turned into one huge
hospital where everyone is everybody else’s humane
nurse.” Goethe’s quote captures the essential ambivalence
of medicalization. On the one hand, it promotes a humane
society, where deviants are treated with kindness and
sympathy and reformed rather than punished, as Parsons
R. Dingwall (*)
Institute for Science and Society, University of Nottingham,
Law and Social Sciences Building, University Park,
Nottingham, NG7 2RD, UK
e-mail: Robert.Dingwall@nottingham.ac.uk
saw in his brilliant analysis of the parallel roles of medicine
and law in social control. On the other hand, it can also lead
to a world where there are no real troubles or conflicts,
merely individual problems in adjustment that can be
corrected with the appropriate chemical or behavioral
interventions.
In its recent history, Conrad notes, medicalization
emerged in the 1970s from the medical imperialism thesis
of the 1960s and shared many of the same assumptions.
Previously excluded or marginalized social groups chal-
lenged the assumed beneficence of the medical profession
and the health care system. Doctors, in particular, were
characterized as agents of a social order stratified by
gender, race and economic self-interest, seeking to extend
their jurisdiction in support of mass oppression. To borrow
from C Wright Mills, medicine was a key agent in turning
public issues into private troubles: women’s depression, for
example, was not a rational response to injustice but a
clinical problem to be solved with the correct medication.
In the process of expansion, doctors acquired wealth, power
and privilege as control agents and, like, any other capitalist
entrepreneur, found themselves driven to create new
markets as old advantages were competed away and profits
fell. Childhood hyperactivity—what would now be called
ADHD—was one example, where the behavioral problems
of US children, faced with an uninspiring educational
system and a domestic environment threatened by the
stresses of mass labor and mass consumption, could be
resolved by medication. The doctors who led this diagnos-
tic innovation and expansion created a new source of profit
and a new area of professional control.
Even at the time, this analysis was questioned empiri-
cally. It was never clear to what extent it held in countries
Soc (2008) 45:382–384
383
where health care was more actively managed by the state,
whether through taxation or social insurance: hyperactivity
never took off on a large scale in the UK or Europe, for
example. As Phil Strong pointed out, in a study of UK
primary care physicians and their alcoholic patients, front-
line doctors in a capitation-funded system had few
incentives to medicalize new problems. It was important
not to confuse the highly visible activities of the profes-
sion’s moral entrepreneurs with coal-face practice. As
Conrad notes, other studies also showed the degree to
which medicalization might be a preferred strategy for
patients, and generate social movements in support of this
goal. Medicalization allowed people with stigmatized
problems to gain access to the privileges of the sick role,
although it has also raised important questions about the
implications of the formation of solidary communities of
the sick, something which troubled Parsons greatly for its
potential in overloading the carrying capacity of even an
affluent society. Conrad also observes that the rise of
complementary or alternative practitioners did not neces-
sarily affect the underlying dynamic of expanded control:
dependence was dependence, whether it was on medication
prescribed by a licensed physician or a herbal product
recommended by a traditional healer. In some respects,
CAM filled the gaps where allopathic medicine hesitated to
meet demands from potential patients to cede responsibility
for their problems. Although
‘right-on’
medical sociologists
might find themselves co-opted to the jurisdictional projects
of CAM practitioners, the medicalization thesis suggests
that we should apply the same critical scrutiny to any form
of healing imperialism.
The biggest gap, however, was, as Conrad points out, a
serious analysis of corporate players. During the 1970s and
1980s, medicalization focused on doctors and patients. If
doctors were agents of white, patriarchal capitalism, the
routes by which this was accomplished were left unspec-
ified and unexamined. In particular, pharmaceutical com-
panies simply made drugs available: physicians took these
up and created the markets for them. Since the 1990s,
however, the drivers for medicalization have been more
clearly identified with the pharmaceutical industry. In part,
this reflects the shift towards managed care and the growing
constraints on diagnostic entrepreneurs in convincing third-
party payers to fund new conditions and associated treat-
ments. Indeed, this often became an issue for patient social
movements: Conrad discusses the example of transsexuals
pressing to retain a psychiatric diagnosis for their condition,
so that they could still get funding for gender reassignment
surgery, in contrast to homosexuals, who sought, success-
fully, to have their orientation removed from the DSM list
of recognized disorders. A potent cocktail of falling returns
from the squeeze on pharmaceutical budgets by managed
care providers, the increasing costs of bringing innovative
products to market and the growing difficulty of discover-
ing new therapeutic entities shifted the drivers towards the
pharmaceutical industry. A key moment in this process was
the FDA Modernization Act of 1997, which permitted
direct-to-consumer (DTC) advertising of prescription med-
icines. The alien nature of the USA comes through strongly
for us Europeans when we turn on the television to be
confronted by a barrage of drug advertisements. Clearly,
there is a somewhat unholy mutual dependence between the
pharmaceutical industry and the mass broadcast media in
the USA. Although sociologists have paid some attention to
the content of the advertisements, their material base seems
to have attracted less scholarly interest, although Big
Pharma must surely rank with Big Tobacco as a social,
cultural and economic interest worthy of scrutiny.
The new frontier, though, according to Conrad, is the
human enhancement industry. Here the potential is unlim-
ited, in the sense that it is largely financed by private
consumption rather than by managed care. Cosmetic
surgery and genetic testing are the goldmines of the early
twenty-first century. Medicine moves on from the definition
of behavioral problems as fit objects for its attention to the
creation of new physical problems. In the UK, our celebrity
magazines trace the breast surgery careers of models and
actresses, for example, where the DD implants of one phase
are replaced by C sizes as the fashion changes. Looking
further ahead, we can see the potential for cognitive
enhancements, achieved through medications rather than
psychological interventions. In the process, our cultures
produce ever narrower definitions of acceptable body
morphisms and mental engagements, definitions that can
rarely be sustained without extensive and profitable
interventions. Paradoxically, physicians may become our
allies in resistance to these processes. If they do not, what is
left of their professionalism beyond a very basic level of
consumer protection?
While Conrad’s book is comprehensive, thoughtful and
reflective in its account of a major contemporary theme in
medical sociology, and will serve well on any course that
examines this topic, there are, perhaps three areas where it
might have been a little more adventurous—and which may
need more attention as the years go by.
One is its ethnocentrism. This is a harsh criticism given
Conrad’s genuine efforts to reflect the contributions of
European writers. Sometimes he does not get us quite right:
the NHS does not, as he correctly says, cover the cost of
Viagra except where certain specified disease states are
present, but physicians are not allowed to charge an extra
fee for a prescription. He does not, too, always use his
obvious knowledge of European health care to probe the
extent to which the contours of medicalization in the USA
reflect a unique constellation of national incentives rather
than generic features of health systems in developed
384
Soc (2008) 45:382–384
countries. What I particularly have in mind, though, is the
situation of allopathic medicine and its associated corporate
interests in countries that have genuinely plural healing
systems. Conrad rightly remarks that we cannot assume that
traditional healers do not engage in medicalization. How-
ever, we do need to give further attention to the extent to
which
‘medicalization’
adequately captures the current
experience of countries like India and China, where
allopathic medicine has not had the socially, legally and
politically entrenched market dominance that it has in the
USA and other developed societies.
A second point, and this is not a criticism of Conrad so
much as of medical sociology in general, is a failure to look
outside the silo. The same society that has been witnessing
a radical expansion of the jurisdiction of its health system
has also been seeing a radical expansion of its legal system.
Medical imperialism has been paralleled by legal colonial-
ism. Indeed, at various points, the two enterprises have
come into competition and conflict. Sociologists of law
have been no better than medical sociologists at acknowl-
edging the co-existence of these twin processes. However, I
would suggest that it makes a considerable difference to the
analysis of each to consider its place alongside the other.
The extended
‘soft
policing’ of the USA by its physicians is
coincident with the expanded
‘hard
policing’ of its law
enforcement system. The USA may be a highly medical-
ized society but it also imprisons and executes a greater
proportion of its citizens than almost any other country. As
Parsons showed us, medicine and law are complementary
systems of social control: the simultaneous expansion of
both surely says something about the nature of governance
in general that has yet to be captured by the specific
sociological studies of either.
Finally, and related to both of the above, I am not sure
that we really understand enough about the drive to
marketization in health care and the withdrawal of states
to minimal roles in consumer protection rather than active
regulation. How far is medicalization a substitute for state
action rather than an alternative or a challenge? I have
recently been involved in some work on the future
organization of the profession of pharmacy in the UK.
Licensing is being removed from the professional associ-
ation and taken over by a state-controlled board, as with all
other UK health professions. Within the English vision of
the NHS, the strategy seems to be to impose a minimum
standard on actors who will then be left to compete for
patients and state-funded services in a more or less
unregulated market. This also reflects the growing inter-
vention into the field of health care, in both England and at
the level of the EU, of government departments and
agencies concerned to promote competition and markets
for professional services, at the expense of those concerned
with health. The case for permitting DTC advertising, for
example, is being pressed in the name of competition and
open markets over the objections of health interests
concerned to manage demand. The English health depart-
ment is increasingly decoupled from any ability to manage
the market in pursuit of public health objectives, although
the Scottish Government is still pursuing central planning
and collaboration with its professionals around a strong
public health agenda. English patients are consumers, while
Scottish patients are citizens of a communitarian welfare
state. If the state sees its role in health care as essentially
residual, providing a minimal set of entitlements with
minimal regulation and relying on competition for patients/
consumers to distribute resources and manage the system,
then medicalization is likely to expand as providers
compete for business. This applies both to professionals
and to corporate interests seeking both to enlarge the
market by introducing new diagnoses or enhancements and
to enlarge their own share at the expense of other actors.
None of these comments should detract from the
intrinsic merits of Conrad’s book. It is an invaluable
synopsis of 30 years’ scholarship that will save many of
us a great deal of burrowing through books and articles. It
is clearly written and presented so that it should be
accessible to students in both sociology and health studies.
Peter Conrad has made an immense contribution to medical
sociology and it is a pleasure to be reminded of this.
Robert Dingwall
is Professor and Director, Institute for Science and
Society, at the University of Nottingham. His Essays on Professions
was published by Ashgate in January 2008.

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