Overmedicalisation

"Fred, you suffer from Self talking syndrome type 2". I turn around, a bit surprised, to my room mate, a doctor from Singapore. He is also a philosopher by nature and I wait for the daily question or theory that he wants me to react on. He continues "You are talking to your computer and that is maybe treatable". And then he starts to explain that this is an example of overmedicalisation, more a joke by him and that we have to find a balance in life. We divert the discussion to long term care - as we are both dealing with that - and conclude that there may even exist something like oversocialisation in some countries. And in other countries undersocialisation (not enough attention for social care) in the aim to come to universal coverage for medical care.

After our discussion, I thank him for finding the topic for my next flight blog (I usually write these blogs in the airplane back home on late Friday afternoons). Last week I already wrote about the danger of using too many medicines, especially when getting older, but the problem of overmedicalization is broader. The overtreatment of the attention deficit hyperactivity disorder (adhd) in kids may be the most well known example, but examples can also be found in fields like depression, sleeping disorders and, hm ok, talking to yourself.

How to define overmedicalisation exactly? Or rather medicalisation because this is how the term was first devised by sociologists in the 1970s. They viewed medicalisation as a form of social control in which medical authority expanded into domains of everyday existence. Doctors were seen as agents of social control. Ivan Illich, a philosopher, in his book "Limits to medicine: medical nemesis", elaborated on this. He stated that the medical profession harms people through iatrogenesis, a process in which illness and social problems increase due to medical intervention. He saw it on 3 levels: the clinical, involving serious side effects worse than the original condition; the social, whereby the public is made docile and reliant on the medical profession to cope with life in society; and the structural; whereby the idea of aging and dying as medical illnesses effectively "medicalized" human life and left individuals and society less able to deal with these "natural" processes (source: wikipedia).

Nowadays and after the roaring sixties and seventies, the criticism has become less sharp and a far cry from the earlier calls for a revolution against the biomedical establishment. Even scholars who critique the societal implications of brandname drugs remain open to these drugs' curative effects. That is probably why we now call it "overmedicalisation" rather than just "medicalisation". But recently the trend is to become more critical again. With the information revolution, more and more people want hard evidence for effective treatments and more and more is known about adverse effects of medicines. Our trust that big companies in banking, food industry and pharmaceuticals are acting in the interest of their customers is under fire with all this new information.

But before turning a revolutionary myself, let me turn back to overmedicalisation and ageing. As Illich already said, ageing should not be seen as an illness in itself. We too often use the words "frail" and "elderly" in one sentence, just because old people react a bit slower and tend to forget things more easy. Of course, they may have more diseases than when they were younger, but ageing itself is not (yet) curable. To make the distinction more clear, I propose that professional care workers who assist old people with activities of daily living (for example washing) are not allowed to wear white or green nursing uniforms. Pink, red or yellow, it does not matter, as long as it is colorfull, showing that ageing is not a disease.

Finally, should I worry about my talking to machines? Probably not as I am just ahead of my time. Computers and mobile devices are already able to deal with spoken comments and that will only increase in future. Whether it is desirable that computers in WHO will learn all types of Dutch dirty words is another matter. After I have left, they will probably need some treatment....