Institute For The Future

What’s in a Name? Strategic "Medicalization"

I recently read an interesting article in the Atlantic about the history of how we came to see alcoholism as a medical disease. The issue of how we talk about mental and physical health problems—what is a disease and what isn't—though, is still relevant today, and will become increasingly important in the future as information technology advances.

 The Atlantic article is primarily about a perceived contradiction between Alcoholics Anonymous’ “essentially lay and spiritually oriented approach to alcoholism” and its push to “popularize the notion that alcoholism was a disease or illness phenomenon… to medicalize alcoholism.” 

The article argues that AA’s probably saw this as an “ unfortunate but necessary subterfuge… to shift the public's image of the alcoholic in a medical direction and thereby also lessened the stigma that kept alcoholics out of treatment.” 

The alcoholism example reminds me a bit of an issue my partner runs into in her work with Oakland’s Cambodian refugee population. Because of the stigma associated with mental health issues in her’s and many other’s communities, her organization often advises doctors and other healthcare providers to focus on the physical manifestations of mental health issues caused by wartime trauma when talking with refugee clients.

What I think this indicates, in regards to the work Health Horizons is doing this year on big data, is that these kinds of sensitivities are going to become more, rather than less important in the future. Essentially, a computer, like Watson, is going to have all the data needed to prescribe the right medicine or course of treatment.  What the computer will not have, at least any time soon, is the sensitivity (cultural and otherwise) to know how best to present that information to patients. (This idea, that technology will increasingly automate quantitative tasks, making that which is intuitive social and human more important, is from IFTF Executive Director Marina Gorbis' forthcoming book). 

I also think big data will challenge the idea that this kind of framing is “subterfuge” at all. As data reveals new correlations between health outcomes and things like social connections, the lines between “mental” and “physical” health problems and solutions will become irrelevant.