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The DSM-IV & The Medicalization of Behavior

The American Psychological Association is revising the DSM-IV. In this post, Stephanie Medley-Rath explores why changes to the DSM-IV are of interest to sociologists.

Grieving Woman

The American Psychological Association is revising the DSM-IV (Diagnostic Statistical Manual of Mental Disorders). The DSM-IV is the manual psychologists (and other medical professionals) use to diagnose mental disorders. This manual provides the parameters for distinguishing unproblematic sadness from problematic depression.

If a condition is listed as a mental illness in the DSM, then an insurance company is more likely to cover some of the treatment costs. The government may use the manual to determine if an individual should qualify for government services. For example, children may qualify for accommodations in schools due to a diagnosis based on the DSM.

Why might a sociologist be interested in this revision?

As a sociologist, this revision process illuminates the medicalization of human behavior.

Medicalization refers to the process whereby a condition not already seen as medical, becomes a medical condition. In other words, a non-medical condition becomes socially constructed as a medical condition. Does this mean the condition really is not a medical matter? No. What it means is that it is being understood as a medical matter.

For example, alcoholism has gone from being seen as primarily a personal deficiency to a medical condition. As a medical condition, individual responsibility can be reduced or eliminated and treatment may proceed along medical lines (i.e., insurance might cover treatment, pharmaceutical companies might develop medications for treatment).

Several items in the proposed revision have received headlines. Take for instance grief. If certain criteria are met, prolonged grief after the death of a loved one could be considered depression. Past revisions of the DSM have shortened the acceptable period of grief. Grief, then, becomes a potentially medical condition in need of treatment.

Are some grieving people helped by medical intervention? Probably, but it is also probable that grieving people could be harmed by medical intervention.

Not only does a medical understanding of grief matter for potential medical intervention, but also for potential criminal prosecution. A grief expert was called on to testify on Casey Anthony’s behavior after the death of her daughter. Ms. Anthony was judged at trial not only for her alleged involvement in the death of her daughter but for grieving inappropriately. Her failure to display grief in a socially normative way increased people’s suspicions of her as a cold-blooded murderer.

How grief is socially constructed, influences whether or not a person is considered sick and potentially even criminal. More broadly, the medicalization of behavior illustrates how “normality” is socially constructed and how that social construction can have a profound impact on all of our lives.

Dig Deeper:

  1. How would you describe the normal grieving process? At what point, should someone seek medical treatment?
  2. Should grief be considered a medical condition? What are the advantages and disadvantages of understanding grief as a medical condition?
  3. There are many conditions that today are treated medically, such as hyperactivity, anxiety, pregnancy, baldness, and height. Do some research to find out how one of these conditions has become medicalized. Is medicalization of this condition a good thing? Why or why not?
  4. Go to your favorite search engine and search “how to grieve.” Visit two or three of these sites and compare the messages these sites send to visitors. How would you revise your description of the normal grieving process in question 1 based on what you learned from these sites?