Medicine as an Institution of Social Control by Irving Zola

The article discusses the potential of the medical profession to manipulate the behavior of society

and leverage the authority given to it by people. The reliance of the general public, on the

medical profession and the word of the medical practitioner or physician, exist not only as a

result of people's lack of conviction in their ability to tackle complex and controversial topics on

their own but also as a result of the medical profession's actions and behaviors. In this overview,

I explain why medicine has such a monopoly over so many aspects of society and human

behavior, and why so many people regard it as absolute authority. I discuss both the medical

profession's dilemma of claiming everything as important to their field and the broader society's

problem of evading moral and ethical duties. Lastly, I will critique the approach of this article

towards understanding the role of medicine in society and in calibrating the impact of technical

language on the perception of the people.

Firstly, the relevance of medicine in everyday living is important to assess. Historically, the role

of the practitioner has not been as intrusive and invasive, as it is now in modern society. The

monopoly of the medical profession on matters relating to disease and illness is not associated

with the ability of the practitioner to cure, heal, or solve the problems of ill health. One thing that

the medical profession utilizes to impact the public’s perception of health and give relevance to

the medical practitioner, is the ‘time-sensitive nature of health. The practitioner is always

relevant in the lives of ordinary people because they are always afraid of falling sick or losing

their health. The time-sensitive nature of human health exacerbates the problem by causing

people to focus on 'preventing' sickness out of fear that curing disease may be impossible, or will
be highly painful, time-consuming, or expensive. As a result, the practitioner gains a tangible

presence in ordinary people's lives, as they rely on his authority to align their behavior with

'healthiness' and to separate themselves from 'unhealthy' activities. However, this intense

intrusion by the physician would not be possible without the perception of the public on their

need for ‘preventing’ disease instead of treating it. The physician establishes his relevance and

persuades people by frightening them with the "what ifs" and mentioning that even the physician

may not be able to help the "potential" patient if the ailment manifests itself in the future. As a

result, the physician's current ability to help, as well as his future inability to help, is stressed in

an attempt to encourage the patient to be concerned about his health even though he feels fine.

Secondly, medicine’s control over certain technical, operational, and legal procedures should

also be discussed, such as the ability to prescribe drugs and medicine. The case of plastic surgery

mentioned by the author perfectly serves the purpose of exemplifying the impact of the physician

on the daily lives of people. The physician has not only objectively and professionally

participated in the setting of unreal beauty standards (especially for women), but he has also

perpetuated the ideas of perfect skin, bone structure, and other possible enhancements.

Therefore, the physician has converted a procedure from only being used for a very specific

population, such as burn victims, to it being used for the ‘enhancement and fine-tuning’ of

people’s appearances. The perception has shifted from the acceptance of elements such as saggy

skin and wrinkles to perceiving these aspects as undesirable and ‘curable’ by the medical

profession. The things that people used to view as natural and inevitable effects of aging are now

seen as flaws that should be ‘fixed.’ Another example is the controversial issue of ‘abortion’,

which is not seen as a moral, ethical, and social problem, but it is instead categorized as a

technical issue which requires expert analysis and specialization. Here, again, the larger society
lacks maturity and irresponsibly outsources the complex and controversial problems to the

domain of medicine, instead of having discussions and conversations regarding the

categorization and perception of this issue as a moral, ethical, and social problem. Furthermore,

medicine's monopoly on drug prescription and marketing of these pharmaceuticals as answers to

human mood issues leads to a psychological interpretation of these drugs as on-and-off switches

that can be controlled and dominated at a whim. These medications appear to be able to fine-tune

our emotions. The difficulty with this understanding is that the public sees its emotions as levers

that can be pushed to any degree to get the desired intensity taste. An issue with utilizing external

elements, such as medicines, to 'manage' our moods and mental states is that it presupposes we

know what is best for ourselves, which isn't always the case.

Thirdly, it is also pertinent to talk about the monopoly of medicine to any form of deviances or

abnormalities. The exclusive access to ‘taboo’ areas of society and behavior sacrifices intimacy

and the ‘forceful alignment’ or ‘homogenization’ is done under the mask of ‘treating’ people

who are (and perhaps want to stay) different. The ability of the physician to label anything

deviating from the norm as an ‘illness’ is problematic because it takes away the scientific

credibility and authority associated with medicine. The objective façade of medicine falls when

the ability of the physician to label any deviance as a ‘medical problem’ is scrutinized. This is so

because historically and geo-spatially the very definition of ‘normal behavior’ has been changing

due to technological revolutions and changing perceptions. For example, female voting was

considered taboo or abnormal before the late 19th century, but it is now considered normal.

Another example can be the interventionist nature of the medical discipline itself. Traditionally,

the role of the physician and the medical profession has not been to intervene in the life of

ordinary people, but it is normal for this to happen in modern Western society. Apart from this,
the author identifies four processes: Aging, drug addiction, alcoholism, and pregnancy.

Similarly, the author has also argued that while aging and pregnancy were seen as ‘natural

processes’, drug addiction and alcoholism were seen as ‘human weaknesses’. However, this

perception has now changed, and medicine has infiltrated all areas of society. Therefore, old

people were expected to pass away, and the process of natural birth was not seen as ‘risky’,

which is now changed because the avenues of medicine have infiltrated these areas of society as

well. Particularly, regarding alcoholism, the author mentions the categorization of alcoholism as

a social evil committed by hedonistic and irresponsible people. As a result, categorizing

alcoholism as a disease has robbed it of its historic meaning and replaced it with an objective,

absolute definition assigned by 'health professionals.' This lowers the guilt felt by people when

indulging in binge-drinking sessions, it impacts their degree of free will, and it also makes

society more dangerous, because people who drink alcohol are more likely to commit crimes

such as murder. (Galbicsek, 2021) Furthermore, the author mentions the modern ‘need’ for

medical supervision while giving birth, and how the interventionist ‘care’ extends to birth, pre-

natal, post-natal, and even pediatric care. Lastly, the medical profession also decides (for two

consenting individuals) not only whether life should begin or not (through their views on

abortion), but also whether the conception of a baby should have or shouldn’t have been done in

the first place through the field of genetic counseling. This medical and professional ‘care’ has

replaced traditional institutions such as family structure and cultural norms. Traditionally, people

sought help and advice from their family members about issues relating to personal problems.

But now they think that health or even advice should always come from a ‘certified’ healthcare

professional. This highlights the success with which the discipline of medicine and the role of the

physician has intervened in the lives of people.

Finally, the importance of jargon or specialized vocabulary must not be overlooked. This is

because language is how medicalization gets and retains legitimacy. The scientific idioms act as

gatekeepers to the field, ensuring that the general public does not grasp what specialists are

discussing or what is published as a study. As a result, the average individual will believe that

everything to do with health, sickness, or medicine is beyond his knowledge. In the case of the

school administration, which hid behind the towering figure of the physician to add credibility to

their dress code and smoking prohibitions, an example of organizations and institutes using the

authority of medicine to dump unresolved disputes into the healthcare realm. This 'dumping' of

conflicts works because the general public, such as students and their parents, will accept the

'expert view' of healthcare professionals silently and compromisingly. This relieves the school of

the burden of dealing with the disagreement by delegating it to the medical profession.

Moreover, it is also important to discuss in-depth, the reasons for the inclination of humans to

give over control and authority to the physician and the medical profession. One reason for this

is the realization of human beings that they are vulnerable and flawed creatures. They think

‘something is organically wrong with me, is there something to be done to make me feel, look,

and function better?’ This desire to fix flaws, enhance experiences, and remove undesirable

elements from life, is a drive towards perfection and an indication of a lack of satisfaction with

our current selves. Therefore, the lack of satisfaction of the current state links itself with the

potential of medicine to enhance the individual, and this is one way that the medical profession

receives its unchallenged power and authority. Another important element is the human belief in

the omnipresence of disorder. This belief is further enhanced by the pharmacological literature,

because the list of ‘unhealthy life activities’ is so long, and the ordinary person is often guilty of

doing most of these activities. Therefore, the fearful individual gives authority to the physician to
dictate his behavior and to tell society which behaviors are acceptable, unacceptable, righteous,

or immoral, based on his ‘expert opinion’ and observation through the medical lens. While I

agree with the fact that some activities pose health risks, and some activities are potentially more

dangerous to our health than others, I also believe that we indulge in activities while keeping

those risks in mind. The elements of risk associated with different activities, and in varying

degrees, are gatekeepers or barriers which make pursuing those activities valuable and

worthwhile. The importance of our health is also driven by the realization that it can be taken

away from us at any time.

Furthermore, an example of the medical profession providing value-judgments is the dialogue at

the conference about laws to ban parents from reproducing potentially unhealthy babies. The

person at this conference states “There is no reason why sensible people could not be dissuaded

from marrying if they knew that one out of four of their children is likely to inherit a disease.”

By saying this, he assumes that ‘sensible’ people can be convinced from not reproducing, and

there is no need for a law to enforce this. The person assumes that abolishing the institution of

marriage and reproduction is the righteous and sensible thing to do. However, the author contests

this by stating that artificial insemination, abortion, taking on the risk of potential health

problems, and even adoption are viable options to consider. These are all viable solutions,

instead of stopping people from not wanting any children in the first place. Another element

relating to the use of language, aside from value-laden, is the depoliticization of issues by using

words that are associated with being a part of the medical domain. The ‘medicalized’ words such

as health and illness act as de-politicizers because the wider public assumes these words to be

associated with human welfare. This assumption is made on the grounds of presuming that
medical professionals never have a political agenda or proclivities; instead, they work

objectively and compassionately to improve people's lives.

Lastly, it is also important to realize that all the blame for the medicalization of society cannot be

put at the feet of the medical profession or the physician, because there are multiple reasons for

it. The biggest reason, as previously mentioned, is the social desire for medicine to use its

potential to improve the lives of people to a near-perfect level. The author contests this by

talking about intervention. He asks why the medical enhancement or healing power is being

prioritized over our control over our lives and what we, as individuals, regard as ‘healthy living?’

He says that living a healthy life is also synonymous with living an uninterrupted life. He also

clarifies that this paper is not an attack on medicine and believes that the practitioners of

medicine cannot be said to be evil, and states that the medical arena is a mere reflection of the

social identity crisis. However, there are a couple of elements in this paper that I found to be

fascinating and worth criticizing. The first of these is the author’s insistence that due to technical

jargon and idioms, the public rarely becomes aware of medicalized terms and surrenders to the

definitions and understanding of the medical profession because they deem themselves as not

expert enough to tackle a complex issue. However, there are times when the public can

overthrow the impact of technical jargon by causing social change through unity and

determination. An example of this is the social change in perception of homosexuality. Since the

average individual used to accept the definition of homosexuality as deviance and saw it in a

negative light, the medical definition of homosexuality also aligned with the stereotypical view.

However, when the public perception regarding homosexuality began to change, the medical

profession also had to change its stance on homosexuality and stop classifying it as an illness.

The people made medical organizations and ‘experts’ change their view by removing
homosexuality from the DSM (Diagnostic and Statistical Manual of Mental Disorders) in 1973

and the ICD (International Classification of Diseases) in 1990. (Drescher,2015) Having said this,

I do not disregard the author’s claim that technical language and jargon impact public perception

and act as barriers to the common person’s understanding. I believe that this barrier is possible to

overcome through social courage, determination, and unified effort. Furthermore, the author

alludes to society, when he is only talking about Western society. This is problematic because he

is using 'society' in a holistic sense but only has experienced his cultural circumstances. The

societies that operate in the East, such as Pakistan, still have the institutions of traditional

wisdom, religion, family structure, and cultural norms to tackle the social and moral problems

that appear in society. Therefore, his analysis of ‘society’ is not holistic, but reductionist. There

are multiple variables at play during the interplay of medical institutions and traditional

institutions, and these include geographic location and time-period or era. It is important to note

that the author’s critique and analysis only remain relevant in a specialized geographical area and

during the modern era.

Bibliography

Galbicsek, C. (2021, April 6). Alcohol-Related Crimes: Statistics and Facts. Alcohol Rehab

Guide. https://www.alcoholrehabguide.org/alcohol/crimes/.

Drescher, J. (2015). Out of DSM: Depathologizing Homosexuality. Behavioral Sciences, 5(4),

565–575. https://doi.org/10.3390/bs5040565

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4695779/