As the world observes World Mental Health Day on 10 October this year, it is heartening to witness an ever-greater awareness of the importance of mental health. In November last year, The Straits Times reported that “[a]wareness of mental health conditions has grown among Singaporeans, with nearly six in 10 surveyed now able to recognise common conditions, while stigma around these issues has also decreased.”1
Such consciousness of mental health is indeed to be welcomed and more effort must be made to reach out to members of the public who continue to harbour stubborn misconceptions. Greater awareness of mental illness would enable people struggling with conditions such as depression and dementia to receive proper care and prevent stigmatisation.
However, greater awareness of mental health issues has generated a phenomenon that cannot be ignored and must be carefully addressed: The medicalisation of behaviour once regarded as socially unconventional.
The medicalisation of society is hardly a new development and has been discussed by sociologists and philosophers for more than two decades. It is given an erudite and comprehensive treatment in an informative book by Peter Conrad published in 2007.2
Simply put, the medicalisation of society refers to the process by which non-medical problems become identified, defined, understood and treated as medical conditions that require diagnosis and intervention by healthcare professionals.
There are many reasons for this trend.
The first has to do with the theory that human behaviour can be explained primarily if not solely in terms of biology. As W. Joseph Wyatt puts it, “[v]arious disorders are increasingly conceptualised in biological terms even when there is either weak, or no, support for that conceptualisation.”3 According to Wyatt, examples include depression, anxiety, attention-deficit or hyperactivity disorder (ADHD), child conduct problems and even schizophrenia.
This is evident in the medicalisation of feelings of anxiety and depression, especially anxiety disorder (AD) and depressive disorder (DD). For example, the American Psychological Association (APA) has gradually expanded the definition and scope of AD and DD. Shyness has become social phobia, and even feelings of bereavement are pathologised.
As Kilian Van Looy and Sarah Vande Velde point out:
… the DSM-V4 discarded the contested ‘bereavement clause,’ which excluded ‘normal’ feelings of sadness from depression, induced by, for example, grieving a close death, thereby inevitably causing diagnoses to rise significantly. 5
If the first cause of the medicalisation of non-normative behaviours is the biologisation of human behaviour, the second is surely the ever-expanding range of psychotropic drugs produced as “treatment”. As Wyatt explains:
The culture’s medicalisation of behavioural disorders has paralleled its increasing reliance on psychotropic medications, coupled with a corresponding weakening of emphasis on non-drug therapies, at least for many clients and professionals.6
A subtle and crude logic guides this perspective: If a perceived “deviant” behaviour (e.g. hyperactivity) can be pharmacologically controlled, that behaviour should be classified as a medical condition.
It is important to make it quite clear that what has been said so far should not be regarded as a denial of conditions such as ADHD or autism. The point of this article is to emphasise proper diagnosis, not denial.
This is important because overdiagnosis and overtreatment (which is what the culture of medicalisation encourages) undermine, from the Christian standpoint, the dignity of the individual. They treat the individual who displays behavioural traits such as hyperactivity or impulsiveness as an object of treatment.
This is important because overdiagnosis and overtreatment (which is what the culture of medicalisation encourages) undermine, from the Christian standpoint, the dignity of the individual. They treat the individual who displays behavioural traits such as hyperactivity or impulsiveness as an object of treatment.
In hastily labelling such behaviour as “deficient” or “pathological”, we even risk denying or failing to appreciate their God-given uniqueness.
Furthermore, in the case of a child, treating certain behaviours as requiring medical intervention may impede him or her in the processes of learning and maturation.
There are also profound social ramifications and dangers in the medicalisation of non-conforming behaviours.
In a medicalised culture, our first instinct when we encounter a restless, energetic child is to ask “What diagnosis explains this?” and “What medication will control it?” instead of “How can I support him and help him to grow?”
We fail to see a child in need of Christian nurture and spiritual formation sustained by a loving family and community. Instead, we see a dopamine dysregulation in need of titration!
When variant behaviours are routinely medicalised, as a society we become less patient and accommodating of people with different temperaments. And in treating certain temperaments and behaviours as “abnormalities” to be corrected or treated, we also slowly lose our ability to love our neighbour as ourselves (Mark 12:31) by respecting their individuality and uniqueness.
Dr Roland Chia is Chew Hock Hin Professor of Christian Doctrine at Trinity Theological College and Theological and Research Advisor at the Ethos Institute for Public Christianity.
1 Li Ying Lee, “Singaporeans More Aware of Mental Health Conditions; Less Stigma over Such Issues: IMH Study,” The Straits Times, November 19, 2024, https://www.straitstimes.com/singapore/singaporeans-more-aware-of-mental-health-conditions-have-less-stigma-imh-study.
2 Peter Conrad, The Medicalization of Society: On the Transformation of Human Conditions into Treatable Disorders (Johns Hopkins University Press, 2007).
3 W. Joseph Wyatt, “Behavior Analysis in the Era of Medicalization: The State of the Science and Recommendations for Practitioners,” Behavior Analysis in Practice 2, no. 2 (2009): 42, https://doi.org/10.1007/bf03391748.
4 The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is the 2013 update to the Diagnostic and Statistical Manual of Mental Disorders, the taxonomic and diagnostic tool published by the American Psychiatric Association (APA). A revised version was published in 2022.
5 Kilian Van Looy and Sarah Van de Velde, “An Examination of the Medicalization and Pharmaceuticalization Processes of Anxiety and Depressive Disorders in Belgium between 2004 and 2013: How May Both Disorders Be Intertwined?,” Archives of Public Health 80 (August 15, 2022), https://doi.org/https://doi.org/10.1186/s13690-022-00943-x.
6 Wyatt, “Behaviour Analysis in the Era of Medicalization,” 49.
