Clinical Review

In search of “non-disease”

BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7342.883 (Published 13 April 2002) Cite this as: BMJ 2002;324:883

On non-diseases and medicalisation

Dear Sir

As a medical sociologist, I read with more than passing interest your
editorial on “non-diseases”. The definition given for a non-disease is “a
human process or problem that some have defined as a medical condition but
where people may have better outcomes if the problem or process was not
defined in that way”.1

The editorial also mentioned the “increasing tendency to classify
people’s problems as diseases”1 or what sociologists call the
“medicalisation” of social problems. Good examples of medicalisation
include “gambling addiction”, “sexual addiction” and “domestic violence”.

There is a concept from contemporary sociology that may be a useful
tool for healthcare professionals when pondering over the issue of
diseases, non-diseases and medicalisation, i.e., the “social construction
of reality” approach. Using this approach, one is reminded that certain
conditions are defined as “diseases” in some societies but not in others,
and that definitions can change over time within one society. Thus, a non-
disease such as overweight/obesity has been medicalised in countries such
as Britain and this medicalisation is probably linked in some way to
increasing rates of eating disorders such as anorexia nervosa among
females and even some males (note that I consider overweight/obesity to be
a non-disease while acknowledging that it is a risk factor for certain
diseases such as diabetes mellitus). Interestingly enough, in traditional
Samoan society, overweight/obesity in women is considered to be desirable
and such women are considered to be “beautiful” in the eyes of Samoan men.
A very fascinating case of social construction of reality indeed! The
chances are that this traditional notion is changing or even disappearing
with increasing “Westernisation” of Samoan society.

The usefulness of this concept is illustrated when we apply it to
other phenomena such as “substance abuse”, e.g., we witness the gathering
strength of the anti-tobacco movement in the United States today as a
result of public health concerns over the effects of tobacco on smokers
and bystanders. However, in the past, tobacco smoking was not considered
to be an unhealthy practice and was even associated with sophistication.
Another example would be the negative perception of the contemporary
American public toward drugs like heroin, cocaine etc. In the past, such
drugs were not considered dangerous and were added to cough syrup
(heroin), patent medicine (morphine) and even Coca Cola (cocaine)!2 I rest
my case.

Competing interests: none

References:

1 Smith R. In search of non-disease. BMJ 2002; 324: 883-5 (13 April).

2. Savage D. Panacea one day, poison the next.
http://www.smh.com.au/news/0001/01/world/world11.html

Competing interests: No competing interests

16 April 2002
Kai-Lit Phua
Senior Lecturer in Community Medicine
International Medical University, Plaza Komanwel, Bukit Jalil, 57000 Kuala Lumpur, Malaysia