Medicalization increases treatment and can harm patients

by James Baker, MD

“Medicalization” is the process of turning problems into diagnoses and people into patients.

According to Dr. Gilbert Welch, “It encourages more of us to be anxious about our health and undermines our confidence in our own bodies. It leads people to have too much treatment — and some of them are harmed by it.”

“Alcohol dependence” and “attention deficit hyperactivity disorder (ADHD)” are among the issues that some call problems and others call medical disorders.

It’s an old argument, but it is renewed in the context of healthcare reform, and the need to control healthcare costs rather than let them bankrupt us all. A recent study claims that the money we spend on these former-problems-of-living-now-medical-diseases is more than we spend on two “real” diseases, heart disease and cancer, combined.

It’s a legitimate argument.

ADHD is a real medical disorder, but it was not long ago that it was thought to be rare: one in a hundred kids, maybe.  Now it is diagnosed in 15 of 100.  Likewise, bipolar disorder is a medical disorder, but its symptoms are now so broad that the diagnosis is often useless in determining treatment or prognosis of many patients given that label. “Medicalization” would also explain why the recent data on anti-depressant effectiveness is so dismal: they’re being used to treat sadness, not just “major depression.”

Here’s hoping that high-quality, psychodynamically-oriented psychotherapy makes a comeback.  My experience is that it’s the best approach to many problems we currently fail to fix with a pill.

James Baker is a child and adolescent psychiatrist with Metrocare Services who blogs at Mental Notes.

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