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At present, research undoubtedly shows an increased amount of life problems being defined

as medical. This begs the question; have medical conditions become more prevalent? Or

could it be that previously unnoticed disorders have now been medically recognised,

diagnosed and treated? This also reveals the evident lacuna in medical research, is there

concrete evidence of every form of condition acknowledged? Mental illness as described by

the DSM-IV is identifiable by psychological distress, impairment in important regions of

functioning, considerable increased risk of death or disability, or loss of freedom, may also

entail specific responses to disturbing life events, and can have either a biological or

psychological dysfunction (Colman, 2006). This is one such area incorporated in the

biomedical model. The biomedical model is unique as regards health in that it selects only a

biological perspective of illness even in the case of mental disorders, and aims to understand

and treat these illnesses without considering psychological or social factors (Marks, 2002).

The biomedical model can be conceptualised as the driving force behind medicalisation.

Medicalisation is the process whereby a previously non-medical condition is described as a

medical problem and is therefore treatable by the medical profession. However, the term

medicalisation in literature generally implies over-medicalisation due to the increase in

everyday life difficulties being diagnosed as medical issues. The interplay between the

biomedical model and medicalisation is apparent when considering how rapidly the idea of

the biomedical model was accepted as the ‘solution’ to many types of illness (Conrad, 1992).

Growth of Biomedical Model

The biomedical model has been steadily increasing in popularity since approximately

the late nineteenth century; many factors have contributed to the acceptance of this model

including social factors such as the attenuation of religion and the strengthening faith in

science (Conrad, 1992). As declared by George Bernard Shaw (1944) in an article in the Irish

Times “We have not lost faith, but we have transferred it from God to the medical

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profession” (Schlesinger, 2002, p.185). However, as unmistakeably evident with religion,

wherever there is faith, there is power. What establishes a problem as a medically

diagnosable illness is greatly dependent on the agency designated with the authority to do so,

which in turn leads back to the abundance of newly recognised conditions, particularly in the

mental illnesses category (Conrad, 2007). It can be conceptualised that the greatest form of

social control possesses the power to determine certain behaviour and its outcome for a

person or population.

Identification of Medical Social Control

Parsons (1951) was perhaps one of the first researchers to identify medicine as an

institution of social control. There has been increased interest in the power of medicine over

societies which can clearly be seen in the case of medicalisation of deviant behaviour. The

ever expanding medical jurisdiction is simply creating more social power for the field. Peter

Conrad has illustrated that “Medical social control is defined as the ways in which medicine

functions (wittingly or unwittingly) to secure adherence to social norms; specifically by using

medical means or authority to minimise, eliminate or normalise deviant behaviour” (1979,

p.1).

Psychiatry and Social Control

Traditionally psychiatry has fulfilled its purpose of mediating medical control in

relation to mental illness. It acts as a control agent by setting and enforcing public mental

health standards and if it becomes necessary, retaining the right to institutionalise those who

are perceived as a possible danger to others or themselves (Conrad, 1979). Throughout the

history of psychiatry there have been many objections to the supposed isolated concern for

mental illness and its understanding and treatment, however, amongst all of those oppositions

Thomas Szaz (1981) has created an inspirational argument exposing psychiatry’s hidden

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element of accumulating social power. Szaz proceeds to describe the type of social power

which was and is held by the discipline of psychiatry, this as he discusses entails the ability to

make a person do something against their will, yet it is seen as ethically justified (Szaz,

1981). Psychiatry in the past did not adhere to the medical ethical standards that are imposed

at present, the state retained the right to incarcerate the mentally ill, however the power

psychiatrists gained also stems from the actions of the state during the eighteenth century

which appointed one man to decide whether or not a person was unfit mentally and in need of

institutionalisation. This also meant that patients were subjected to surgeries such as

lobotomies and were forced to consume medication which had not been fully tested

(Moncrieff, 2003). Ethical issues became more prevalent during the mid twentieth century

and thus a modern version of psychiatry emerged.

Psychiatry and Pharmaceuticals

Psychiatry still holds the monopoly regarding the treatment of mental illness and

appears to rely almost completely on the biomedical model view of treatment. In the United

Kingdom in 2007 it was found that ninety eight to one hundred percent of psychiatric

inpatients are prescribed medication with an overwhelming amount ingesting many types of

medications at once. Regular drug rounds are carried out each day with hesitant patients

being forcefully injected. It was also revealed that ninety per cent of outpatients are also

being prescribed psychotropic medication (Moncrieff, 2009). The power of psychiatry as the

implementation of the biomedical model is unquestionable, yet it is not simply affecting

patients resident in mental institutions. Psychiatrists and the pharmaceutical industry work

together to develop psychotropic medications for patients suffering mental distress, however,

despite seeming beneficial this alliance between psychiatry and pharmaceutical industries has

proven detrimental to the previous social norms. Along with the release of antidepressants

such as Prozac and Zoloft in the nineteen nineties, psychiatrists and pharmaceutical

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companies such as Eli Lilly joined forces to campaign and promote mental illnesses such as

depression as medical conditions. This created a surge in patients being diagnosed with

depression and in turn boosted pharmaceutical sales (Moncrieff, 2009). Positive effects of

newly manufactured drugs such as Ritalin led to an increase in reliance on psychiatry for the

treatment of mental illness as the public belief was that a psychiatrist can truly understand

mental illness and thus the use of the biomedical view of treating mental disorders flourished

(Moncrieff, 2009).

Medicalisation and ADHD

Unfortunately due to the power of psychiatry as the single unit recognised for

diagnosing and treating mental illness, the ability of this field to broaden its medical coverage

has been witnessed several times. For example the formation of ‘intermittent explosive

disorder’ as a medical condition treatable by psychotropic medication is in itself evidence of

the interplay between pharmaceuticals and psychiatry and of the social control the discipline

has gained (Moncrieff, 2009). The extent of the biological basis of such recently discovered

disorders has not yet been comprehensively studied and it must be debated that perhaps

society are being controlled through manipulation with the intention of widening psychiatric

and pharmaceutical catchment area. A recently established disorder aimed predominately

towards children known as Hyperkinesis or Attention Deficit Hyperactivity Disorder is newly

recognised under DSM-IV criteria however stimulant drug treatment for ADHD was

discovered twenty years previous to its recognition (Conrad, 1975). ADHD includes the

following symptoms: hyperactivity, inability to retain attention, restlessness, fidgetiness,

aggressive behaviour, sleep problems and impulsivity. These symptoms can also be

categorised as deviant behaviours but psychiatry has classified them collectively as a mental

disorder which is more prevalent in boys than girls. The treatment advised by psychiatrists is

the use of stimulants such as Amphetamines and Ritalin. Despite acknowledged side-effects

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these psychotropic drugs have shown to ease disruptive levels of behaviour and have thus

promoted the diagnosis of ADHD for children previously regarded as ‘problem’ children.

Now a well known disorder, ADHD or Hyperkinesis is recognised as the most commonly

diagnosed and over-diagnosed child psychiatric disorder. Disruptive behaviour in children is

without a doubt undesirable and therefore it can be a relief to families if their child is given a

diagnosis of ADHD and is prescribed drugs which are aimed at calming the child’s

behaviour; however this further restricts the amount of acceptable behaviour as seen by the

public and so psychiatry through altering social behavioural norms establishes its power by

tightening its social power and control. What is not explained to patients or families of

ADHD diagnosed children is that the commonly prescribed drug Ritalin can be seen in many

ways as a rather generic drug also used in the treatment of narcolepsy, appetite control,

depression and fatigue. Unfortunately in spite of the evidence or lack of for the use of

stimulants when treating ADHD, many children have reported feeling more socially accepted

while on their medication, which in turn convinces the child to adhere to the social

behavioural boundaries created by the biomedical industry (Conrad, 1975).

Children and Medication

Even w hen knowledge of the partnership between psychiatry and pharmaceutical

companies is evident; organisations such as the national institute of mental health (NIMH) in

the US still support projects implementing experiments using psychotropic drugs on children

labelled with behaviour disorders. Despite the awful effects of such behavioural social

control, funding remains plentiful and children are being medicated with anti-depressants

such as Prozac (Breggin and Breggin, 1998). It is unfortunate that human behaviour involves

complex occurrences such as the bystander effect which teaches society to look to each other

to learn how to behave. This human trait allows psychiatry to gain more social control as

individualisation is clearly ignored in medical cases under the biomedical view. A child

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diagnosed with ADHD is diagnosed based on their behaviour at school and/or at home and in

public, however, the disruptive behaviour shown by the child could be a result of their

experience of their environment and simply their reaction to how they perceive the stimulants

in their environment. The biomedical model as defined above purely focuses on biological

aspects of behaviour and thus attempts to justify the advertised view that medication is the

answer. Another flaw evident in human behaviour is the irrational belief that medication

takes the role of the ‘magical cure’, as the pioneers of the study of human behaviour this is a

well known phenomenon in the psychiatric arena and may feature in the achievement of

social power and control (APA, 1994).

Medical Collaboration

The biomedical model itself is not as efficient without contributing external

agencies. In the past the social control of psychiatry was used to suppress unwanted public

opinion, depoliticisation of deviant behaviour was put in place to declare political dissenters

of the Soviet Union mentally ill in an attempt to institutionalise them and avoid public

defiance (Conrad, 1975). A less extreme example of government involvement within the

biomedical field is investigated by Moncrieff (2003). In the UK in 2002 a new Mental Health

Act was proposed by the department of health which intended to extend the boundaries of

psychiatry and to increase the power of psychiatrists in enforcing medication or treatment

from a biomedical perspective, and to increase the capability of a psychiatrist to subject a

patient to compulsory detention. This act intends to further expand the social power of

psychiatry as the agent of the biomedical view. Fortunately this act was adequately exposed

and was thus opposed by many organisations including the Royal College of Psychiatrists

(Moncrieff, 2003).

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Patient-Physician Relationship

What has not yet been considered is the social control willingly offered to

agents of the biomedical field. Doctor patient interaction in itself forms a level of social

control for a number of reasons, firstly the patient expects that the doctor has been educated

to the extent that he or she is capable of diagnosing an illness correctly and it is assumed that

the doctor will also be able to prescribe suitable medication or treatment for a particular

illness. The fact that it is almost essential to make an appointment and that the patient must

most often visit a clinic also professionalises the view of physicians. The patient has a certain

degree of dependency on the doctor as it is expected that medicine is his or her area of

expertise, more so than the patient. This creates faith in the doctor and builds up a powerful

rapport between the physician and the community which also creates control. As regards

psychiatry, patients visit a psychiatrist with the hope that the psychiatrist can explain and

treat their mental torment, trustworthiness is expected from the psychiatrist and along with

that follows power (Sorenson, 1974).

Medical Excuse

Another aspect to the medical professional’s social control involves being the

final decision maker as regards the ‘sick role’. This particular element of the medical

profession empowers the psychiatrist with the ability to excuse a particular patient from

certain life obligations by diagnosing them with an illness either temporary or lifelong

depending on each situation. Perhaps the highest form of empowerment regarding the ‘sick

role’ is when a psychiatrist is called upon to analyse a serious criminal justice case for which

an insanity defence could be included. In capital crime cases psychiatrists could determine

the outcome of the whole court case and the implications of that decision would affect the

lives of each participant in the court case. This is social power in the extreme; essentially the

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psychiatrist can decide whether or not to help clear the defendant. This shows the evident

control held by the psychiatry discipline as the final decision makers (Conrad, 1979). Other

examples of the power of the biomedical professionals include the ability to discharge a

person from the military by providing medical grounds on which they are incapable of

participating in military defence, providing a medically legitimate excuse for a civilian to

avoid jury duty, providing medical notes to explain absence from work or school, or simply

to provide medical notices to excuse late assignments for students (Conrad, 1979). This

category of social power is referred to as ‘the power of medical excuse’ (Halleck, 1970).

Stigmatisation

It must be said that a salient factor in assessing psychiatric power and control is the

stigma attached with mental illness. This stigma reveals a completely different area of social

control in which the idea of being labelled as ‘mental’ will unintentionally control social

behaviour. The biomedical model would view a mental illness as biologically based and it

could therefore be accepted that no mental illness is short term or easily ‘cured’. This for

society means that if diagnosed with a mental illness, the label is not simply temporary but

long lasting and could have negative implications on future employment prospects. The

recommended treatment in accordance with the biomedical model is psychotropic medication

which is not completely side-effect free nor inexpensive and those reasons alone will grant

the profession with social control over behaviour due to the fear of being different or

excluded from society (Link, Cullen, Frank, and Wozniak, 1987). In a study directed by Link,

Cullen, Frank, and Wozniak (1987) the effect of a label of mentally ill in society was

investigated, research showed that a label such as mentally unwell adapted the master status

in society and stigmatisation and rejection followed.

Media Influence

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An organisation often involved in gathering support for a proposition in any discipline

is the media. The media subjects people to bias, prejudice and propaganda, therefore

manipulating people into thinking and believing what the advertiser wants them to believe.

With such power of persuasion it comes as no surprise that the pharmaceutical companies use

advertising to promote their products for the prevention and treatment of psychiatric

disorders. The pharmaceutical industries avail of the tactic propaganda to modify people’s

beliefs about mental illness, by portraying depression as a widespread mental illness more

people will believe they are depressed and will be prescribed with anti-depressants and in

turn raise the profits for the pharmaceutical companies. The company Geigy Pharmaceutical

Company Ltd., released a drug called Tofranil which they advertised as specific in the

treatment of depression. This further supports the public view that mental illness has a

biological basis and that the biomedical model is the appropriate and effective model to apply

when considering mental disorders (Moncrieff, 2009). Nevertheless, it is often not considered

that as a direct result of the persuasion of the public in favour of the medical model many

unpleasant effects can be witnessed. Firstly the pharmaceutical sales of psychotropic drugs

will soar, Moncrieff (2009) identified a two hundred and forty three per cent rise in

antidepressant prescriptions within a ten year period ending in 2002. With a higher demand

for antidepressants comes a possibility to make considerable profit and therefore it was

identified that the price of antidepressants in the United Kingdom rose by seven hundred per

cent in that same ten year period (Moncrieff, 2009). In reflection, not only has there been a

significant increase in the diagnosis of mental illness, but the price of the apparent cure also

increased, dependency on the biomedical sector is steadily rising consequentially creating a

monopoly for the treatment of mental illness and this positive outcome from the viewpoint of

the pharmaceutical industry will ensure the further medicalisation of everyday life problems

(Moncrieff, 2009). It is evident that the biomedical model which was once purely aimed at

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understanding and treating biological bases of mental illness has now evolved and is being

exploited to earn money at the expense of a dependent and trusting society.

In conclusion it can be debated that the biomedical model due to its restrictions to the

biological bases of mental illness is perhaps not the most accurate model to apply when

diagnosing a mental disorder, instead it is proposed that a bio-psychosocial model be

employed in order to avoid the problem of individualisation apparent with the biomedical

model and to more comprehensively understand mental illness (Engel, 1997). Another flaw

with the biomedical model is the inconsistency of positive results and the inability to predict

their effects or side-effects, also the medication prescribed for mental illness in line with the

biomedical view seems to be very generic and lacking specificity. However, in spite of that

the power accumulated by the medical arena over time has created such an influence that

social control has been ensured whether through dependency, fear of stigmatisation, and

enforcement or medical excuse. The influence of the biomedical department can clearly be

identified and has proven its strength by crossing language and cultural barriers (Marks,

2002). The biomedical view in understanding and treating mental illness is still expanding

and has undoubtedly functioned as a form of social power and control.

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