Raimo Tuomainen: Medicalization and paramedicalization - why and how; and what are the visions?

I have published, alone or with my team, three Finnish books dealing with medicalization - and a great number of articles. Our newest book (Tuomainen R, Myllykangas M, Elo J, Ryynänen O-P. Medikalisaatio - aikamme sairaus. Vastapaino, Tampere 1999.) has attracted an unexpectedly wide attention in Finland.

Here you have the English summary "Medicalization and health" of my book (published in Finnish: Tuomainen R. Medikalisaatio ja terveys. Publication Series of the Pohjois-Savo Hospital District 30/1996. Kuopio 1996.):

The judicial and medical institutions have the legitimacy of creating deviance categories. In the 1900's, medicine became supreme: in practice many things labelled to badness belong now to illness. Medicalization means the expansion of medicine - many fields of normal human life and deviation have become in the focus of medicine. The most typical meanings of the concept 'medicalization' are dealing with the status of medical profession or, on the other hand, controlling social phenomena. The third dimension of this term is the judging of human life in association with health, in light of the newest medical knowledge.

During the last generations public health in modern countries has developed in a positive direction. People have learnt to avoid suffering, which is nowadays considered purposeless and must be eliminated. However, only a fractional part of people's daily symptoms leads to using health care: medicalization has a fruitful substrate to extent.

The wideness of prevailing health concept is an indicator of the state in medicalization process. The widening of the concept makes the relation between society and the health of its members clear, which consolidates health promotion in society. A good example of a diffusion of the wide health concept and the emphasis on the health effects is the model of community diagnosis.

Medicine has been blamed as being imperialistic. The tendency to expand is, however, typical for any human institution. Medicalization is connected with six needs in our society: on micro level 1. the need for belief in authority, 2. the need for liberation from guilt by externalizing problems, and 3. the need to direct narcism; on the macro level 4. the need for controlling deviance, 5. the need for promoting market system, and 6. the need for supporting the contemporary social power structure.

According to Festinger's theory of cognitive dissonance a human being tends to search and emphasize information, which is in harmony with one's own outlook or action. The theory led to highlighting the idea of commitment. As Western people avoid many health hazards, they are committed to caring for one's health. People are also integrated to the meritocratic ideology, the cause of a massive marginalization. However, working-aged are predominantly in a situation that feeds conformity, ie. in ruling one's life the success strategy. The most definite type of success strategy is healthism.

Doctor's duty is unfortunately dual: to understand, and to judge. A biomedically oriented practitioner is in danger of losing the grip with patient's subjective experience. Alienation from the part of human being which is scientifically unexplorable may not serve the cause for health. As an antithesis for medicalization there is the process of paramedicalization: emphasis on health beliefs outside medicine is increasing. Traditional or alternative medicine has a huge area to operate with. It reaches to every human activity - even to the time beyond birth and death. Medicalization has much stricter borders.

Medicalization is a threat, if health behaviour becomes a new marginalizing factor: people polarize in medicalized and hazard actors. Self-destructiveness should be accepted as a substantial part of human nature. Knowing the risks does not necessarily liberate, but means also anxiety. Ethical norms must guide health promotion, medicine, and especially genetic improvement.

The idea of medicalization has no unreserved approval. The theories about medicalization have been seen too narrow, and the conceptional determination is the weak point. In Finland arguments dealing with medicalization are quite rare: the health care system is considered as an unselfish attender.

English medicalization sites: Tampere University, course "Health values, media publicity and citizens":: Medicalization (Myllykangas and Tuomainen)

This is a list of those fellows worked with me studying medicalization: Riitta Ahonen, Jyrki Elo, Juha Kinnunen, Petteri Mehto, Markku Myllykangas, Pekka Piironen, Olli-Pekka Ryynänen, Heikki Tikkala, Eeva-Liisa Tuomainen, Maunu Tuomainen, Minna Tuppurainen, Eeva Töyry ja Anne Waldén. As a result we have made many Finnish articles.

Back to Finnish, siis jos englannin kieli ei tunnu hyvältä
raimo.tuomainen@kuh.fi Sosiologian kotisivu Sociology Home Page


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