Medicalization is defined as “a process in which non-medical problems become defined and treated as medical problems, usually in terms of illness and spending” (Conrad, Mackie and Mehrotra 2010, 1943). According to Peter Conrad (2007; 2010), medicalization is a social process, and in-principle, is neither good nor bad. Whether medicalization is judged to be good or bad depends on many considerations, such as consequences, rules, motivations, and relevant impact on economics and institutional practices. I think examining claims about the medicalization and validity of ADHD has, in a rather circuitous way, interesting implications for the ethics of neuroenhancement, specifically arguments for use of pharmaceuticals to augment a person or their neurological capacities.
To begin, I think that medicalization does raise many concerns. I think that there are problems with remedying the disposition of shyness or sadness with medical treatments. Yet, it is the concern that medicalization does not raise for me that is interesting. I am not concerned that medicalization is more of a social process and less of an empirical and scientific process. Consider that for a long period of modern medicine homosexuality was considered a psychiatric condition or disorder. It was not until a majority of psychiatrists voted it as not being a mental disorder that it was removed from the medical canon as a condition or disorder. In this case a majority of psychiatrists agreed, and correctly so I believe, that being a homosexual was not a condition or disorder requiring medical treatment. Yet, notice that while these psychiatrists’ votes were cast on the grounds of their professional experience, it is not as if this decision, for lack of a better term, was based on empirical findings of the time.
I am also not concerned that medicalization of a condition or disorder is often founded on complex and deeply ingrained societal norms and values. The recent prominence of erectile dysfunction (ED) as a medical condition or disorder illustrates the complexity and ambiguity of societal values and biomedical technologies and medical procedures working indirectly to medicalize something. ED, unlike what was traditionally regarded as impotence for psychological reasons, occurs when a man is physiologically not able to develop or maintain an erection for sexual intercourse. It is clear that having the ability to develop or maintain an erection is rather important for society and for most men. There are many conditions under which ED is a medical condition or disorder, resulting from prostate cancer or diabetes. However, considering human evolution, it is not at all evident that human males past their reproductive prime were physiologically meant to be able to develop and maintain an erection. ED was not a problem until society advanced to the point where men living beyond their reproductive prime were common. That there was a pharmacological treatment for ED and the value of still being able to have a sexual relationship even past a man’s reproductive prime, led to the medicalization of ED.
As the examples of homosexuality and ED demonstrate, societal norms and values in conjunction with advances in scientific understanding and biomedical technologies and procedures often indirectly (or directly) dictate what things are to be medicalized. This means that one could, for sake of the argument, hold that the validity of Attention Deficit Hyperactivity Disorder (ADHD) as a medical condition or disorder is irrelevant. That reading, writing, and academics are highly valued by our society is enough to warrant ADHD as being considered a medical condition or disorder. That there was a pharmacological treatment for those to reach certain levels of being able to read and write and the value that these skills have in our society warrants the medicalization of ADHD. That this is not a “real” medical condition or disorder seems, like certain instances of ED, not all that important. Although I think that ADHD is, in fact, a real medical condition or disorder, one need not hold this view to argue for its medicalization.
At least one interesting implication from medicalization and the validity of ADHD as a medical condition or disorder for neuroenhancement is that it illustrates that the permissibility of an enhancement may be dependent not only the particulars of a person’s situation but also on norms and values of that society. Thus, some arguments about the permissibility of neuroenhancements might want to restrict or move away from claims that rely on reasons for enhancement to be about increasing human well-being in general and focus on reasons relating to increasing well-being for persons in a particular society. This narrowing of focus, in turn, may allow for a deeper investigation of the norms and values that underwrite the reasons for, or against, the use of neuroenhancements. For example, that the U.S. does value education for its ability to develop the intellectual capacities of persons —despite the claims of a state legislator in Tennessee who seems to think that education is about making students gay— is a strong and tangible reason for permitting cognitive enhancers. It is the more fundamental societal norms and values, particular to a certain society or community, that underwrite the permissibility of neuroenhancements and this need to play a greater role in the enhancement discussion.
Conrad, Peter. The Medicalization of Society: On the Transformation of Human Conditions into Treatable Disorders. Baltimore: The Johns Hopkins University Press, 2007.
Conrad, Peter, Thomas Mackie, and Ateev Mehrotra. “Estimating the Costs of Medicalization.” Social Science and Medicine 70 (2010): 1943-1947.