The medicalisation of normal women

Dr Snellen

Dr Martien Snellen, a Perinatal Psychiatrist from Melbourne, Australia, posed two questions during the Medical Lecture Series: “Has the medical tradition of a diagnosis seeking a cure been replaced by a tradition of a cure seeking a diagnosis? Are we medicalising and pathologising normality when it comes to women’s mental health?”

Medicalisation is the process by which human conditions and problems come to be defined and treated as medical conditions. Not so long ago, sociologists devised the concept of medicalisation to explain how medical knowledge is applied to behaviours which are not self-evidently medical or biological.

Interventions affecting perfectly normal female functions such as the menstrual cycle (premenstrual syndrome), menopause and female sexual functioning are rampant because according to the Western medical model, these conditions have been labeled as diseases. So, when does a discomfort become a disorder? When does a symptom become an illness?

“It has long been recognised that many women experience a predictable, cyclic pattern of symptoms which begin in the late luteal phase of the menstrual cycle and ends shortly after menstruation begins,” stated Dr Snellen. Adding that the symptoms may cluster and include physical, emotional, psychological, and behavioral components such as headaches/migraines, abdominal cramping and bloating, backache, weight gain, emotional irritability, anxiety, depression and many others, Dr Snellen stated that more than 50 percent of the world’s female population experience this on a monthly basis. That is about 2 billion women - which is a huge market!

In 1953, Green and Dalton published that Premenstrual Symptom (PMS) was responsible for decreased worker productivity, increased divorce rates and murder! In an article published in 1996, a debate broke out - symptoms were culture bound, and represented an unnecessary pathologising of cyclical changes in women with the diagnostic category potentially being harmful, as it could lead to women believing that they are mentally ill. This would lead others to mistrust them in situations as important as job promotions or child custody cases. Others argue that it was a valid condition that was poorly studied because it did not affect men.

Premenstrual Dysphoric Disorder (PMDD) was said to affect 3.7% of women worldwide. According to an article published by Severino in Harvard Review of Psychiatry in 1996, coding PMDD as depression was said to encourage clinicians to view women with PMDD as depressed. This indirectly encouraged women with the condition to view themselves as depressed.

So, does the emotional and physical changes that may accompany hormonal fluctuation determine what it is to be a normal woman?

Some medical researchers, health care providers and drug companies have defined menopause as a hormone deficiency condition due to ovarian failure. According to this view, menopause is a condition like thyroid deficiency or diabetes. If it is left untreated, we will be at greater risk for many chronic diseases, a lower quality of life and premature death. Dr Snellen asked: “Should we replace the word deficiency with reduction, and the term failure with closure?”

During the decades that followed, drug companies promoted and doctors prescribed hormones to women to prevent and treat an increasingly broad range of ailments.

The Monash Malaysia Medical Lecture Series is organised by the Jeffrey Cheah School of Medicine and Health Sciences, who jointly supported this above lecture together with the Monash Education Academy.