The Medicalization of women’s bodies in the era of globalization
In this article, I would like to share some ideas about the medicalization of health and specifically of women’s bodies and health as an aspect of globalization.
The patriarchal system is effectively based on the control and appropriation of women, especially our bodies. The control of our movements and attitudes, of our sexualities and fertility, of our life cycles, of our pregnancies and births, of menopause and aging, the control of our overall health is in the hands of “experts.” This control is essential for maintaining patriarchal sovereignty and the economy. There are many who control our bodies and who reap a considerable profit from our bodies, our sex, our reproduction, our beauty, our labor, everything. They become very wealthy at our expense.
The history of western culture is marked by the transformation of the human body through a variety of practices, and medicine is historically the key institution in the regulation of the body. In this brief article I wish to present some ideas on the cultural construction of the medical system, beauty as health and the production of and experimentation with certain drugs.
The Medical System: A Cultural Construct
Part of medicalization is the medical system’s labeling of each woman who is diagnosed and the meaning of the illness initially imposed by cultural expectations regarding that specific health problem.
As with other institutions, the medical system operates within a cultural paradigm. The medical system and illness itself are steeped in assumptions that are derived from this very paradigm. The central paradigm is reflected in the language and in the actions involved in the process of healing in western culture.
The predominant paradigm of western medicine is “medicine is science.” This paradigm serves various functions.
Above all, the medical system is one of the institutional riches of capitalism, and as such it is led by the business of medicine: hospitals, medical insurance, pharmaceutical companies and, in developed countries, the cost-watchdog businesses, large industries whose interests revolve around profit.
The paradigm of “medicine is science” hides the fact that medicine is a business and supports the assumptions that:
1) Western medicine (that of the U.S. in particular) is the best;
2) The doctor knows what is best for the “patient;” and
3) The use of invasive procedures and expensive technologies should not be questioned.
“Medicine is science” is based on reductionist methods that promote another paradigm for treating the body: “the body is a machine.” This paradigm suggests that the body can be separated into discrete parts and that the broken parts can be fixed. This vision treats the “sick parts” without understanding, much less facilitating, the body’s natural capacity for wellness. Illness is seen as something that must be dealt with from outside the body, thereby justifying aggressive treatments. This has naturally led to the development of harsh chemical treatments that target specific parts of the body. The so-called side-effects on the other parts of the body are down-played.
“Medicine is science” has also promoted the idea of the separation of body and mind, favoring the development of allopathic medicine. A gender perspective shows how men used this concept to create a monolithic system that prohibits other practices of healing and that requires women’s submission.
It is interesting to observe how doctors feel uncomfortable with women’s emotional reactions, for example, when they are told the results of a diagnosis. Many physicians attempt to comfort the women by prescribing medication.
There persists the idea that illness is an individual problem that can be solved by “medical science.” The experiences of a patient who enters in conflict with the medical system rarely are viewed as legitimate (Petersen and Benishek, 2001).
Beauty as Health
In 1991, Naomi Wolf’s book, The Beauty Myth, drew attention to the billion-dollar cosmetics industry and the relation between women’s beauty and medicine. Twelve years later her arguments still stand true. Indeed, the phenomena she describes have grown worse, multiplied and are increasingly incorporated as “natural” aspects of women’s lives.
The cosmetic surgery industry is expanding through the manipulation of ideas about health and illness. There is a very clear historical precedent for what plastic surgeons are doing. As Susan Sontag explains in Illness as Paradigm, “healthy” and “ill” are often value judgments that society uses for its own purposes. For many centuries the definition of “ill” has been a way to impose social control over women.
Now cosmetic surgeons are co-opting the feminist re-definition of health as beauty and inverting it to promote the idea that beauty is health (and hunger is health, and pain and blood are health). In this new re-classification, clearly-defined beauty is juxtaposed with ugliness. This is very serious. We are surrounded by very clear images and messages that tell us how we should look, and how we most definitely should not look. Women who think that they are suffering from the ills of ugliness (and I believe that a great many do) feel that they can be cured or feel better if they have cosmetic surgery or buy more clothes or make-up–in other words, by consuming.
This industry has re-classified and redefined the body: the size of our hips and thighs is seen as a medical concern; breasts are described as atrophied after a woman stops breastfeeding; and healthy female skin is describe as cellulitis, a condition invented by Vogue magazine in 1973. Plastic surgeons talk about the “deformities” of aging.
Everything that is deeply and essentially feminine–life expressed in our faces, the feeling of our skin, the shape of our breasts, the transformations and changes in our skin after childbirth–is being reclassified as ugly and ugliness as an illness. One-third of women’s lives are marked by aging, one-third of our bodies are fatty tissues, and both of these have been transformed into surgically-correctable problems. So women can only feel healthy if they are a third of their natural selves.
Behind it all is profit–it’s all about money in the end. The cosmetic surgery industry is a billion dollar industry. In order to guarantee their income, plastic surgeons distort women’s self-perception and magnify their self-hatred and rejection. We see it every day in the media, the magazines, medical brochures, television, the movie industry, the newspaper, and advertising, ad nauseum.
The Global Drug-Pushers
The information in this section is a summary of Jackie Kennelly’s master’s thesis in environmental studies and was originally published in The Monitor of the Canadian Centre for Policy Alternatives.
“Women, in particular, are vulnerable to the changes being wrought in the name of globalization. To illustrate this, let’s look at the pharmaceutical industry and its impacts on women’s health.
“Women consume between 60% and 70% of pharmaceuticals worldwide, largely due to the fact that [we] generally take full responsibility for contraception. This leaves [us] more vulnerable to the machinations of the pharmaceutical industry, as well as making [us] a key market to be targeted. This combination has resulted in various health care disasters over the last 40 years or so.
“Three examples that may be familiar to [some of us] are the DES cancer daughters, the Dalkon Shield fiasco, and the Depo Provera controversy. Each of these stories received significant press coverage in their time; each then faded into relative obscurity. Each is also an example of how the quest for profits by some pharmaceutical companies resulted in the deaths and suffering of thousands of women around the world.
“DES, or diethylstilbestrol, is a synthetic estrogen that was prescribed to women from the 1940s until the 1970s to prevent miscarriages. Evidence soon began to mount, however, that DES might increase risks of cancer and perhaps even increase the risk of miscarriage. Nonetheless, the pharmaceutical industry continued to push the drug on medical doctors and encouraged them to prescribe it to pregnant women.
“It was not until 1971–some 30 years after DES was introduced on the market–when Dr. A. L. Herbst established the connection between a rare form of vaginal cancer in the daughters of women who had taken DES during pregnancy, that the pharmaceutical companies began to respond.
“Their response, however, was slow. In the Netherlands the Ministry of Public Health told the pharmaceutical industry that the use of DES during pregnancy was banned; in spite of this, the directive ‘for use in cases of risk of miscarriage’ continued to appear on the package inserts until 1975.This breach is even more astounding when considered in light of the fact that Eli Lilly, the prime manufacturer of DES in the United States, conceded in a trial that it was aware by 1947 that prenatal DES posed the threat of cancer to pregnant women, that it had been shown to cross the placental barrier, and that it had caused malformations in the offspring of pregnant mice.
“Lest we think that the DES story ended there, it continued to be distributed to countries of the South and prescribed to pregnant women to prevent miscarriage as late as the mid-1980s.
“The Dalkon Shield was an intra-uterine-device (IUD) form of contraception for women. There are several different brands of IUDs, and all IUDs come with the risk of infertility caused by pelvic inflammatory disease, or PID. This is problematic enough on its own; however, the Dalkon Shield came with a risk of PID that was five times greater than that faced by other IUD users. Unlike other IUDs, the Dalkon Shield had been marketed by its manufacturer, A. H. Robins, as the first IUD specifically for women who had not yet had children. This is rather remarkable, given the known risk of pelvic inflammatory disease with IUD use and its link to infertility.
“Another unique aspect of the Dalkon Shield was its connection to septic abortions (abortions accompanied by toxic infection). Of the 287 septic abortions caused by IUDs that the U.S. Food and Drug Administration had recorded by 1974, 219 of them were caused by the Dalkon Shield. Fourteen shield users also died.
“Although A. H. Robins, the Dalkon Shield manufacturer, had notice of these adverse effects as early as 1971, it not only continued to market its IUD, but covered up the negative results of its own studies. In the trials that later ensued, a former Robins attorney testified that he was ordered to destroy evidence of the negative health impacts of the Shield.
“In 1972, aware that they would need to ‘diversify their markets’ if they wanted to stay in business, A. H. Robins executives contacted the Office of Population at the U.S. Agency for International Development (USAID) and offered a 48% bulk discount on unsterilized Shields. The Shield was then distributed in 42 Third World countries; what’s more, there was only one set of instructions for every 1,000 Shields and in only three languages: English, French and Spanish.
“Depo-Provera, another contraceptive drug, was involved in a particularly long and drawn-out approval process by the U.S. Food and Drug Administration (FDA). Many animal studies had shown multiple adverse effects, including uterine cancer in monkeys, breast cancer and tumors in dogs, and deaths due to Depo-Provera-induced diabetes in dogs. Although not approved for contraceptive use in the United States until 1992, USAID advocated the use of Depo-Provera in family planning programs in the Third World before this time.
“As in the cases of DES and the Dalkon Shield, the possibility of corporate deception looms. Upjohn Corporation, the manufacturer of Depo-Provera, has been accused of withholding evidence of multiple health risks for many years while it promoted the drug worldwide.
“As an injectible drug, with contraceptive effects lasting from three to six months, Depo-Provera is seen as an excellent candidate for population control strategies in the South. But […] when considered from the perspective of women’s rights to control their own fertility, [the results are very negative]. For example, if a woman experiences one of the many common adverse effects of Depo-Provera such as depression, hair loss, headaches, weight gain or loss, menstrual spotting, heavy bleeding, amenorrhea (absence of menstruation), anemia, skin changes, and/or loss of libido, there is nothing she can do until the injection wears off. Its injectible nature also opens [Depo-Provera] up to the possibility of abuse since it can easily be administered without full explanation of its effects or side-effects.
“While the use of Depo-Provera has not come to the point of litigation, as in the cases of DES and the Dalkon Shield, its high potential for abuse, its multiple adverse side-effects, and its possible long-term effects make it a likely candidate for legal action, as were its contraception predecessors.
“Of course, one significant difference lies in the demographics of women who use Depo-Provera; that is, most of them live in the Third World where weaker regulations exist and where women are less aware of–or even have fewer–legal rights. That this is the case points again to the role of profit in guiding the decisions of pharmaceutical manufacturers: with less likelihood of litigation, they are more free to dispense risky pharmaceutical drugs in the pursuit of the highest profits.”
The Suspicion Meter and Informed Consent
The list of suspicious drugs is a long one. It includes hormone replacement therapy for menopause, contraceptive pills, antibiotics, throat lozenges, headache tablets, anti-depressants, etc. As early as 1979, Dr. Robert S. Mendelsohn dared to denounce the abuse of medications and the widespread use of dangerous procedures for what he called “non-illnesses,” for example, unnecessary cesareans and episiotomies.
He compared the medical institution to a religion: the physicians are the priests, and the people are urged to have faith. This faith leads us to blindly and ignorantly hand ourselves over to the experts as docile and submissive subjects. Mendelsohn encouraged us to be heretics. Of course, some of us have asked questions, even researched our symptoms and the medications we have been prescribed. But when it comes right down to confronting the experts, our words bear little weight. Our intelligence pales, and our bodies no longer belong to us.
Some of us may think that we have already liberated ourselves and that matters of beauty or contraception are no longer relevant to our lives, because after all, we are older, or lesbians, or feminists. However, this issue transcends our individual lives and choices, and we cannot ignore the magnitude of the problem that it represents for women collectively. This is a political issue that affects the health of all of us.
The result of non-critical medical thought backed by the powerful medical and pharmaceutical industry is people’s dis-empowerment: women (and men) are made more dependant and truly ill instead of healthy. The pharmaceutical industries push for the rapid “diagnosis” of supposed depressions so that the expensive treatment can begin earlier and last longer. A similar attitude can be seen with regard to all of women’s cycles, labeled as pathological for many centuries. Each year new diagnoses are invented, and new drugs are created; this is how the experts and the pharmaceutical companies justify their existence.
How do we change this situation? By developing a finely-tuned “suspicion meter” and by keeping informed. By undertaking our own research and by sharing it with other women through all the means at our disposal. But above all, by involving ourselves in the creation of our own health, making ourselves the central priority in our own lives. We alone are responsible. If we have to take medication, then let us do so with fully-informed consent after all, many of us do need certain drugs. But we don’t need a pill for each and every thing. A significant part of our health problems can be resolved by changing our diet, changing our sedentary lifestyle, or sometimes by changing our job or even … our partner!
Kennelly, Jackie (2002). “The Global Drug-Pushers: Globalization is Not Good for Women’s Health,” in Monitor (Canadian Centre for Policy Alternatives) July/August. On-line at www.policyalternatives.ca/
Mendelsohn, Robert S. (1979). Confessions of a Medical Heretic. Chicago: Contemporary Books.
Petersen, Suni and Lois A, Benishek (2001). “Social Construction of Illness,” in Minding the Body. Psychotherapy in Cases of Chronic and Life-Threatening Illness. Ellyn Kaschak, ed. New York: Haworth Press.
Wolf, Naomi (1991). The Beauty Myth. New York: William Morrow.
The author, a Costa Rican anthropologist and historian, is the founder and current coordinator of the Asociacion de Mujeres en Salud (AMES, Association of Women in Health). She presented this paper at the 9th Latin American and Caribbean Feminist Encounter in Playa Tambor, Costa Rica, December 2002.
COPYRIGHT 2003 Latin American and Caribbean Women’s Health Network
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