November 2003

Medicalization

by Dr. Christopher Kent

A recent article titled "Retail Therapy" [1] caught my attention. It described the results of a study where "compulsive shoppers" were treated with either the drug citalopram or a placebo. The lead researcher was thrilled with the results: "Patients said to me, 'I go to the shopping mall with my friends and I don't buy anything.'" Well, this patient at least bought something ‑‑ the notion that excessive shopping is a disease to be treated with medication.

What constitutes excessive shopping? The article states that one of the subjects "owned 55 cameras." I once collected cameras. Perhaps that makes me a "victim" of this disease. By the way, the treatment came with a price ‑‑ "some side effects, which include loss of sexual desire and sleepiness. The study further admits, "It is not known why citalopram is effective for treating compulsive shoppers."

With big pharma seeking new markets for existing drugs, and developing drugs in search of diseases, it is not surprising that many of life's challenges are no longer considered legitimate components of the human experience, but are now medical conditions amenable to treatment.

Webster's New Universal Unabridged Dictionary [2] defines "medicalize" as follows: "To handle or accept as deserving of or appropriate for medical treatment. Sato [3] offers a more specific definition for medicalization: "A process or a tendency whereby the phenomena which had belonged to other fields like education, law, religion, and so on have been redefined as medical phenomena."

Examples abound in psychiatry's code book for psychiatric disorders and "conditions or problems...which may be a focus of clinical attention and require appropriate coding... This remarkable tome is DSM‑IV. [4] DSM‑1 was first published in 1952, titled, Diagnostic and Statistical Manual of Mental Disorders. My journey into DSM‑IV made me think I had fallen into Alice's rabbit hole.

Do you have difficulty sleeping after drinking coffee? The problem isn't a product of your poor judgment in guzzling java immediately before retiring. You are a victim of 292.89 ‑‑ Caffeine‑Induced Sleep Disorder F15.8. If you reflect on your shyness while tossing and turning, the problem could be the epidemic of 300.23 ‑‑ Social Phobia F40.1. Don't worry. Drug treatment is available. Unfortunately, if you're thinking about your place in the cosmos or spiritual issues, you've got V62.89 ‑‑ Religious or Spiritual Problem Z71.8, and I couldn't locate a drug for that.

Bad parenting is about to become a thing of the past. It's not your fault, or your child's fault. Besides the ubiquitous pandemic of ADHD, there are other disorders you may not be aware of. Your ill‑behaving child may be suffering from 313.81 ‑‑ Oppositional Defiant Disorder F91.3. If your child often argues with adults, loses his or her temper, deliberately annoys people, etc., you're dealing with ODD. Of course, this must be differentiated from 312.8 ‑‑ Conduct Disorder F91.8, and 312.9 ‑‑ Disruptive Behavior Disorder Not Otherwise Specified F91.9. Should the problem be getting along with a brother or sister, the condition is V61.8 ‑‑ Sibling Relational Problem F93.3. And should you argue with your spouse about whether the child should be grounded or drugged, you might be looking down the barrel of V61.1 ‑‑ Partner Relational Problem Z63.0.

If math homework is a challenge, be sure to check for 315.1 ‑‑ Mathematics Disorder F81.2. You must be careful not to confuse this with a V62.3 ‑‑ Academic Problem Z55.8. If things are OK in the math department, but you have a teen experiencing uncertainty about life goals, career preferences, values, loyalties, etc., you're dealing with 313.82 ‑‑ Identity Problem F93.8. This has been downgraded from a "disorder" in DSM‑III‑R, to a mere "problem" in DSM‑IV. I'll bet that makes you feel better.

A plethora of sexual issues are described as "disorders. We are all familiar with Bob Dole's making "erectile dysfunction" a household term, with the blue pill offering a solution. But that's just the tip of the, um, iceberg. If the target of your libidinal interest is ignoring you, the problem may be 302.71 ‑‑ Hypoactive Sexual Desire Disorder F52.2. Lest anyone be offended, I will not address the other disorders codified in Chapter 20. Simply be happy that there are solutions that do not require you to address issues in your relationship. Men can obtain testosterone cream if a doctor determines that it's "right for you." The stuff is said to work well. According to an ad in JAMA [5], "Sexual enjoyment and satisfaction with erection duration were improved vs. baseline, but these improvements were not significant compared to placebo." The ad shows a couple dancing, a couple riding a motorcycle, and two pictures of men swinging golf clubs (alone) and smiling.

Perhaps the next version of DSM will have a category for "golf disorders. "

References

1. Wood H: "Retail therapy." Nature Reviews Neuroscience 2003;4:700.

2. Webster's New Universal Unabridged Dictionary. Barnes and Noble. New York, 1996.

3. Sato A: "Medicalization and medicalization theories." http://www.let.kumamoto‑u.ac.jp/satoa/art02.html

4. Reed WH, Wise MG: "DSM‑IV Training Guide." Brunner/Mazel, Inc. Philadelphia, 1995.

5. JAMA 2003;290(11):1427.

(Dr. Christopher Kent, president of the Council on Chiropractic Practice, is a 1973 graduate of Palmer College of Chiropractic. The WCA's "Chiropractic Researcher of the Year" in 1994, and recipient of that honor from the ICA in 1991, he was also named ICA "Chiropractor of the Year" in 1998. He is director of research and a co‑founder of Chiropractic Leadership Alliance. With Dr. Patrick Gentempo, Jr. , Dr. Kent produces a monthly audio series, "On Purpose," covering current events in science, politics and philosophy of vital interest to the practicing chiropractor. For subscription information call 800/892‑6463.)