Medicalizing

Social Justice Usage

Source: Wann, Marilyn. “Fat Studies: An Invitation to Revolution” (Foreword). In Rothblum, Esther, and Sondra Solovay (eds.), The Fat Studies Reader. New York University Press, 2009, pp. xiii–xiv.

Calling fat people “obese” medicalizes human diversity. Medicalizing diversity inspires a misplaced search for a “cure” for naturally occurring difference. Far from generating sympathy for fat people, medicalization of weight fuels anti-fat prejudice and discrimination in all areas of society.

New Discourses Commentary

“Medicalizing” something is making it medically relevant or coming to view or understand it in medical terms, especially when this is considered unwarranted. This concern is particularly important when issues that would have been better dealt with in other ways are made into medical ones. There are debates, for instance, about whether addiction should be considered a kind of physical or psychological disease (which medicalizes it) or if it is better viewed as a social issue (which does not medicalize it). As a process, medicalizing can be a policy or other institutional decision, and it can seen as a result of applying narratives—asserting a kind of story that shapes how one interacts with facts—or of discourses—ways of speaking about things, particularly here in medical terms.

For the uses of the term “medicalizing” in the Theory of Critical Social Justice, which is rooted primarily in the analysis of ideas, knowledge(s), speech, and discourses, and their relationships to social power, the last two of these are most interesting, though the institutional definition will still be made use of at times. That is, Theory is particularly concerned with the way people speak and think about various social constructs related to matters of identity, and how those discourses and mindsets create and maintain, or disrupt and dismantle, systemic oppression of the relevant identity groups.

Within the broad scope of the Theory of Critical Social Justice, medicalization is considered a significant concern primarily in three specific critical theories and their related activism: fat studies, disability studies, and queer Theory, though in terms of the last, it can feature to some degree within gender studies as well. “Medicalization,” in Theory, usually refers to using medical discourses to describe factors as knowledge that it believes should be thought of as matters of identity. It can also refer to the same issue as generated by narratives that are pushed by people who think in medical terms, whether they are doctors using genuine medical discourses or not (e.g., the fitness industry).

Generally speaking, “medicalization” is viewed by adherents to Theory as a problematic. That is, making a matter of identity medically relevant in some way is viewed as creating a kind of oppression that leads people to view that identity factor as a problem to be solved rather than a way of being. This perspective is applied especially to body weight status and obesity, dis/ability status including mental illness and other deviations from being neurotypical (e.g., autism), and sometimes to issues of identity relevant to sex, gender, and sexuality (see also, transgender)—though, of some note, apparently not to “traditional masculinity,” which was medicalized by the American Psychological Association in 2018 (presumably because the power dynamics don’t preclude such a designation).

In these critical theories, “medicalizing” discourses (or narratives, depending on how they’re being analyzed) are considered to justify and legitimate systems of power that marginalize, exclude, minoritize, and oppress groups and ideas that fall outside of the normal in some way (see also, hegemony). This attachment of oppression to what seems like making and applying statements of medical fact proceeds from a belief that is rather common in Theory: that if there is some official or scientific reason to believe something is abnormal, especially in a negative way, then there is an authoritative justification to stigmatize people who identify as that status, which in turn maintains the power dynamics that generate dominance and oppression (see also, fatphobia, fat stigma, thin-normativity, ableism, ablenormativity, disableism, normativity, cisnormativity, transphobia, homophobia, and heteronormativity). This view conflates descriptive normality (most people happen to be like X) and prescriptive moral normativity (people should be like X).

Viewing medicalizing narratives and discourses this way is more or less a direct derivative of the Foucauldian notion of biopower, which comes from postmodern philosophy. In short, biopower is a concept forwarded by Foucault as the application of scientific discourses (especially those in biology, medicine, and psychology) to control the population by telling them what is and isn’t true in an authoritative way. The Theory of Critical Social Justice is slightly more cynical in its understanding of biopower and extends the idea to claim that it is the “unjust” and uncritical application of scientific “truths” specifically to limit the ways people can be, usually in ways that make people more normative. While this understanding of biopower is somewhat naive to Foucault’s intentions with the concept, it is also undeniably a result of his critical genealogical thinking about the history of social constructions with medical relevance, particularly madness and homosexuality (see also, objectivity and positivism). In Theory, following Foucault’s earlier writing, medical narratives, in particular, are used primarily to identify dissidents, label them abnormal, and then justify using medical treatments to make them more normal—or to exclude them from society if that is not possible.

There are, of course, certain grains of truth to this line of thinking, especially looking at the ways homosexuality and madness—along with issues of women’s health—have been treated historically, including as medical science and psychiatry slowly evolved (and made some pretty horrendous mistakes along the way). Nevertheless, critical theories like fat studies, disability studies, and queer Theory (and to some extent gender studies and sometimes feminism and women’s studies, with some appearances even in critical race Theory) are particularly paranoid and cynical with their understanding of biopower. As a result, adherents to Critical Social Justice hold views of the perils of medicalizing narratives and medical discourses that can extend well beyond the confines of reality, in some ways to the point of being positively dangerous in their own rights.

For example, in fat studies, a central concern of the entire project is problematizing and denying any medicalization of obesity, which they always render in scare quotes (“obesity”). That is, fat studies believes that considering obesity to be a medical issue, or even an issue that is medically relevant in any way whatsoever, is problematic, thus illegitimate. Such “narratives,” they contend, justify fatphobia and fat stigma while upholding thin-normativity. These features, fat studies identifies as a form of violence against fat people, and, in fact, treating obesity as a potentially curable health problem is openly regarded in the more radical strains of fat studies as an attempted “fat genocide.” Fat studies is also profoundly skeptical of (read: hostile to) both “healthist” and “nutritionist” narratives, which are also medicalizing in their own ways. These are the views that health and nutrition have something to do with well-being, and they’re deemed, from within fat studies and neighboring fields, to be problematic narratives that uphold oppressive ideologies. This example of radical skepticism of science and medicine is utterly detached from reality and objectively dangerous (see also, realities and truth).

Similarly odd and dangerous examples of denial of medical facts arise within disability studies. On the one hand, viewing a disability as a potentially medically relevant or treatable problem can be held in similar suspicion as we see with obesity in fat studies. By making a disability into a medical problem (or something that is potentially correctable or curable), critical disability studies see mostly an authoritative discourse that renders people with disabilities “abnormal,” “in need of fixing,” and potentially “less worthy” (see also, crip Theory). This can lead to generating social pressure within disabilities studies communities that recommend avoiding such interventions in favor of maintaining a disabled identity (see also, identity-first and identity politics). Thus, on the other hand, this skepticism of medicalizing narratives leads some people to adopt treatable mental illnesses as identities. It also tends to lead to a radical distrust of doctors (often called “people with letters after their names”) as being unqualified to make diagnoses, especially of mental illnesses, on the grounds that the doctors merely went to school to learn about these diseases and do not possess the relevant lived experience to know them (which is available only inside the head of the person self-diagnosing). This leads to a radical denial of medical expertise and the relevance of medicine to many forms of psychological illness and or neuro-atypicality.

Within the particularly radical and queer approach to disability studies, including “crip Theory,” this radical skepticism of medicine is taken to even further heights. There, the very idea that doctors and other healthcare professionals are qualified to diagnose disorders—especially mental illnesses and deviations from being neurotypical, like autism—is itself seen as an unjust application of power and way to stigmatize disabled people. This leads adherents to this extreme branch of Theory to strongly favor self-diagnosis and deny that any sufficient medical expertise exists to apply medically relevant labels, such as “autistic,” “depressed,” or suffering from any number of personality disorders. These problems then are, instead of being diagnosed and possibly treated, held up as factors of identity that are most relevant under an intersectional framework of oppression. In this line of thought, self-identifying as mentally ill or disabled is considered a positive good (whether one has been diagnosed as such or not) while “being labeled” with these statuses by the hegemonic authority of medical science is profoundly problematic and oppressive. Suggesting treatment is even worse.

A radical skepticism of medicalizing narratives and discourses is also particularly poignant around the issue of any relationship between sex and gender and thus becomes of interest in queer Theory and gender studies around the issues of transgender, non-binary, and other gender non-conforming identities. In particular, claiming that any of these identities are ever caused by any kind of medically relevant issue—e.g., paraphilias such as autogynephilia (in which men have a sexual fetish about viewing themselves as women), associating any sort of gender nonconformity with mental illness even when that’s true, discussing the possibility of a kind of socially contagious “rapid-onset gender dysphoria,” etc.—is deemed problematic. These sorts of claims are considered so problematic among activists (especially trans-rights activists) that they are viewed as forms of violence that justify being answered with (literal) violence (see also, genocide and violence of categorization).

Though it is less common to hear about “medicalizing” outside of these contexts, it is not unheard of. Whether the term is used or not, however, a similar radical skepticism of medicalizing narratives and discourses is also relevant—though to less extreme degrees—within other branches of Theory. It appears within women’s studies and feminism in varying measures, for example by appealing to historical claims that doctors insisted women suffered “hysteria” in order to control unruly women (like feminists). This, of course, is partially true. One might note that getting the American Psychological Association to list traditional masculinity (see also, hegemonic masculinity and toxic masculinity) as psychiatric disorders, as happened in 2018, was not considered problematic, however, but instead important for achieving “Social Justice” (see also, masculinities studies).

Similar appeals are made on racial lines within critical race Theory, often citing horrific historical experiments like the Tuskegee Syphilis Experiment, as a means of identifying problems of systemic racism and anti-blackness. These sorts of problems are then implied to be continuing still—as Theory tends to be this pessimistic—often to justify diversity, equity, and inclusion programs.

Related Terms

Ableism; Ablenormativity; Anti-blackness; Anti-essentialism; Biological essentialism; Biopower; Blank slatism; Cisnormativity; Community; Crip Theory; Critical; Critical race Theory; Critical Theory; Dis/ability; Disability studies; Disableism; Discourse; Dismantle; Disrupt; Diversity; Dominance; Equity; Exclusion; Fat stigma; Fat studies; Fatphobia; Feminism; Foucauldian; Gender; Gender nonconforming; Gender studies; Genealogy; Genocide; Healthism; Hegemonic masculinity; Hegemony; Heteronormativity; Homophobia; Identity; Identity-first; Identity politics; Ideology; Inclusion; Injustice; Intersectionality; Knowledge(s); Legitimate; Man; Marginalize; Masculinities studies; Minoritize; Misogyny; Narrative; Normal; Normativity; Nutritionism; Objectivity; Oppression; Patriarchy; Positivism; Postmodern; Power (systemic); Problematic; Problematize; Queer; Queer Theory; Race; Racism (systemic); Radical; Realities; Reality; Science; Sex; Sex essentialism; Sexism (systemic); Sexuality; Social construction; Social Justice; Theory; Thin-normativity; Toxic masculinity; Traditional masculinity; Transgender; Trans-rights activists; Truth; Violence; Violence of categorization; Woman; Women’s studies

Additional Examples

Source: Wann, Marilyn. “Fat Studies: An Invitation to Revolution” (Foreword). In Rothblum, Esther, and Sondra Solovay (eds.), The Fat Studies Reader. New York University Press, 2009, pp. xiii–xiv.

Calling fat people “obese” medicalizes human diversity. Medicalizing diversity inspires a misplaced search for a “cure” for naturally occurring difference. Far from generating sympathy for fat people, medicalization of weight fuels anti-fat prejudice and discrimination in all areas of society. People think: If fat people need to be cured, there must be something wrong with them. Cures should work; if they do not, it is the fat person’s fault and a license not to employ, date, educate, rent to, sell clothes to, give a medical exam to, see on television, respect, or welcome such fat people in society. Such hateful attitudes are acceptable because no one really believes that being fat is any kind of disease. If fat people suffered from a real illness, our detractors’ attitudes would be unacceptably cruel. The pretense of concern for fat people’s health wards anti-fat attitudes against exposure as simple hatred. Belief in a “cure” also masks that hatred. It is not possible to hate a group of people for our own good. Medicalization actually helps categorize fat people as social untouchables. It is little surprise, then, that when fat people do fall ill, we get blame, not compassion. We receive punishment, not help. Medical cures are inappropriate when applied to social ills. Such a misdiagnosis can be very dangerous. Ascribing illness to everyone whose weight falls above an arbitrary cutoff inevitably yields mistakes—when I give weight diversity talks, I say, “The only thing that anyone can diagnose, with any certainty, by looking at a fat person, is their own level of stereotype and prejudice toward fat people.”

…

Source: Guthman, Julie. “Neoliberalism and the Constitution of Contemporary Bodies.” In Rothblum, Esther, and Sondra Solovay (eds.), The Fat Studies Reader. New York University Press, 2009, p. 188.

At the outset, I wish to acknowledge that “obesity” is a medicalized term that does violence to fat people. Yet, because my argument rests in part on how “obesity” has become a powerful, disciplining discourse, I will use the term throughout the chapter in reference to the discourse, duly marked with scare quotes, but otherwise I will use less loaded terms when referring to body size. I trust the reader to recognize the difference. The primary arguments of the chapter will be developed in three different sections. First, however, I take a closer look at popular renditions of the foodscape argument and discuss its thinness.

Viewing the Foodscape

Amid the moral panic that pervades current discussions of an “obesity epidemic,” some scholars and food writers are searching for more reasoned explanations that do not medicalize fatness or place inordinate blame on fat people. Aiming to shift responsibility for “obesity” to the public policy arena, many of these authors are looking to show how various aspects of the U.S. regulatory environment and economy have contributed to growth in girth. Most of these authors, however, steer clear of the substantive body of scholarship in the political economy of food, and instead resort to more simple arguments. Nevertheless, because most of the authors cited have so contributed to current discussions of “obesity,” we must take their work seriously.

Revision date: 8/10/20

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