Wouat and Àr{cdicalization: A Ncw pcrtpcctipc

Tlre term mzditalizirti,;t,l rcÍi-;-s ro lrio iirrtt-relatcd(ici5 li, r\\r, ::t:Jri('lJtcd nri)ccsscs. itrsl. ccrtJiijF-i

4V

4

targ:6 in thc cxparxion of mcdiclic. Thcsc scholars havc analrzed ho*,prcvious rcligious justifications íor pauiarchy rvcre transformcd into scientificones (Ehrcnrcich and English 1979). They he'c described ho*- nomen,straditional s.kills for rnanaging birth aad cuing for úc sick rrerc cxpropriatedby psychomcdical expcrrs at úe end of the ninetccnth ccntu4, 1ÉhrenreichT1 _r"d.rtt 1973). Feminisr *ritcrs ha'e describca oe mitpte rvays in*4rich *'omcn's healú in úc contcmporary pcriod is being icoparáizedb1, a male coatrolled, rechnologl'-dorninated medicat .r.. q,i..- jDreifus1978; Frankfort 1972; Ruzek 1978; Seaman 1972). Thcse .átio h",o b..r,1mno11nt

vgices in changing * omen's consciousncss about úeir hcalth. Theyha'e idendfied the scxual polirics embcdded in conccptions of sckness anábeliefs^about appropriate care. In addiiion, úey havc providcd üe anall'ticbasis for a social mol/ernent úat has as im primary g"d rh. reclainrinj ofknow'ledgc about and control orer nomen's bodics.

This papcr s,ill eltend úe feminisr critique \ emphasizing som€ ne-glected dimcnsions ofrnedicalization and * ome nos rires. iu,il argue úat boúphysicians and rvomen ha*e contributed to úe redeÂning of *'omen's cxpe-ricnce into medical categories. .\Iore prcciscll', I u'ill suggesr thar physiciànsscek to medicalize expericnce becausc of rhcir specific b.ti.6 *a i.onomicinterests. Thesc ideologicai and material :,oti'es arc rerated ro üe develop-ment of úe profession and úe speciiic market conditions it faces in an1, gi.,enperiod- lvomcn collaborate in úe rnedicalization proccss bccausc of ttrcir o*.nnceds and morives, u'hich irr rurn gro\r'our of úc class-specific narure of theirsubordination. In addition, oúer groups bring economic intcrcsts to whichboth ph1'sicians and *'omen arc responsi'e . Thus a conseflsus dererops that aparticular human proble m rvill be understood in clinical terms. This conscnsusis tenuous because it is fraught *'ith contradicdons for s,omen, since , as statcdbefore, úe1'stand borh to gain and to losc iiom this redcfinition.

I *ill explore tliis thesis b' c.ranrining . . . chilcibirtir [anci] rcproductivccontrol. . . .

fh6 |',[sdiceIization Frameri.ork

:\

our expcriencc of thcm has bcen transformeci. For rvomcn

t nomen have bccn thc main

Women and Med icalizationA Netv Perspective

CernrzuNp Kolrun furssrm-x

Illncss expands bv mcans ofnro h1'porheses. The 6rst is that

ctcri'torm ofsocial deviation can be consiucred an illntss. Thus,

ifcrirrinal bcharior can be ccnsidcred an illncss, thcn crininals" ' - r?c'nôr-td bi idn'dcmriêd or punishef b:ut tcr bt urÍdenlood-(as. ' -

r docror understands), trcated, curcd. Thc second is üat everr'

illncss carr be considtrcd psl'chologicalh'. Illness is interpreted as,

besicelli', a ps1'chological elcnt, and people are encouraged ro

belicrc that thev get sick bccausc theç (unconxiouslr) s'sn1 16,

and that thcl'can cure úcmscltcs b.v úe rnobilization oiuill; thar

thet can choosc not to die of thc discasc. These nvo hrpthescs

arc <omplcrncntarl'. fu thc first scems to reliete guilt, the second

rcinstates it. Pstchological thcorics ofillncss arc a pou'crfirl means

of phcing tlrc blamc on thc ill. Paticnts *'ho arc insuucted that

tlret hatc, unt'itting[1', causcd thcir discase are also made to ttel

that thcv heve <lescn'cd it.

Sus.ru Sosraç, 1979

It is s'idcl1' acknorvlcdged that illncss has becomc a culrural rnctaphor fora vxsr arrrv of hurnan problcms. Thc rrrclllcai n!{ci is trsc.i froni birtl: tod.t'ad}.[n-tLelo.iâkonqtructial]úrealiq:-Iii$o-çkâllv, as, !]llsr nuntbe!of critical cvcruÉBçl-l]uman '

()rir.:n:llv irutrlisircd irs "\ibrncn and Mcdicaii;:atíor::Á Ncrr lcrste ctilc,- (lathcriiic K- llic:;:;iil:n-.. 1...-.,. .,...:..,..\v..:.|::,:)l,(\'()l:!]]:l1tÍ'l,Ôi'I1l..)_lÕ..)/r.,nl,,'l1l,})ilUt|l|\l|Cr1()\.\1^i.1'

\' ... \' -,1- \'\' I rrlr lr.

femiiiists have not' sâiqcdand lost ç,iú the

IlCil;'.'iCrSCfCOnd:l;í)i:i:,;-i.::,,.- r..:,.-: ,...,,,;,,,,-.i.r,;.,i,.ii.,,,,iirrt,..,r,.

THE SOCIAL CO}'STRUCZON OF WOMET|'S BODIES

§phcres of deviance úathavc come under mcücal social control (Ehrenreich and Ehrenreich 1978;Freidrcn l97A1,Z-ola 1972). \rariou§ human conditions such as alcoholism,opiate addiction, and homoscxuality-s'hich at one time u'ere categorized as

'bad'-have morc rccendr becn classified as 'sick" (Conrad and SchrreiderI980a). Currently, more and more of human experiencc is coming undermedical scrutinl', resulting in rr'hat Illich (1976)has calleci'.§.-.p"çdigliaqgo:af [L] For cxarnple, it is nou'considered appropriate to consult physi.;"r'ttabout scxualiq', fertiliq, childhcod behavior, and old-age men'rorv problems.It is important to note that the nredical profession's iurisdicrion over thesc

and oúer human conditions crtends considerabll' beçond iu demonstraterlcapac§ to 'cure" úcm (Freidson 1970).

Thcre is disagreement abiout rvhat causes medicalizarion. Some hai'e

assumed úat úe cxpansicr, of rr,edical iuri«ilction is üe outcome of *medic.rl-impé;alisri--",i

àiroir on úe -pait'or *e -piàttssio"

ro ii',cii"i.-i1-Jpo*'e r(Illich 1976). Oúers have argued thât an increasingh'complex tecl'rnical and

bu;eaucratic society has lcd to a relucmnt reliance on scientific erpcrts (ZolaL972, L975). Othcr scholars have stresscd the u'als in rvhich the medicalestablishment, in its úrust to professionalize, organized to create aud thcncontrol markcts (I^arson l97V). ln order for the occupational strateg' ofúis ernerging professional class to succeed, it rtas necessarv to control rhc

mcaning of úings, includin-s interpretations of s1'mptoms and beliefs abouthealú carc. Stated d.ifferenrlr; professional dominancc could be achieved onlvif people could bc convinced of the medical nature of úeir problenrs and tl.reappropriateness of medical tÍcatment for úem. Thus phvsicians, as par! ofan occupational strategl', creatcd conditions under u'hich thcir advicc seemed

appropriate (Starr 1982 )-In spitc of the disagrcemenr alrout u'hat motivares medicalization, therc

is a consensus úat it has mired cffects. Grcatcr humanitarianisnr, tolcrancc,and oúer benefits associated n'ith *progrcss" Ína1' be morc like h'u'ith medical

definitions than u,ith crinrinal oncs. Yct medical labcling also has ncgarivcsocial consequences. Far from reducing stignra, thc labcl of illncss nla)' crr:-

ate de'.'iance. For exainplc, thc carccr of a psychiatric p,rtierit lregins u'itlia cliagnosis of schizophrcnia. Ás a rcsuit, fanrih' and tricnds perccive and

intcrpret the patient's bchavior in light <-lf rhc illness, cvcn rficr thc acutc

s\lnptoms subsiCc (I'lills l9ó2;. Ât:othcr c()nscqiicrtcc oi nrcciic;riizatiorr is

tl:at the shroud of nrcd;c;l iengulqt i.-r,r;tiiits hltniait pr'<;lt!ttns. :rnd tltus

'.'cmovcs thcm fron-r ptrl:iic ,ic'l ,ti. i il,.,,i rrt'-i ;ii':.1 3cli ncitl':r i >r li í).r r. .:. ricskiiit lr :

lltouuu and ){cdicali=ttion: A New Prrryectioe

of the populace takes piace u'hen cxperrs mânâge human erpericnces, Theapplication of medical definitions makes it more likch'that medica.l remedicsndl be applied, therebv increasing the risk of iatrogenic diseasc. In addidon-both the meaning and intcrpretation of an erperience is tran.?rmed rvhen itis scen as a diserse or svndrome (Freidson 1970). For example. rhe mcaningof murder is significandl altered x'hcn rhe label of "sociopathic personaliq.;is uscd ro âccounr for the behavior. In this s'av, moral issues tend not befaced and nlal- nor eren be raised (Zola 1975). Finallv and most imporrant,a\\'âre ness of üe social causes of disease is diminishcd rvith medicalization. ÁsStark and Flitcraft (1982) state:

r\{edicinc amracts public resourccs out ofproportion to its capacin tor hcalthe nhancemcnq bccausc ir oÊen categorizes problems fundemcntallr social inorigin as biological or personal de6cits, and in so doing smothcrs úe impulselor social chenge s'lulh could offcr úc onll'serious resolution.

to nredical labeling. For cxample, children's beharior is medicalized underúe ruLrric of jurcnilc delinqucncy and h1'perkincsis (Conrad and Schneidcr1980a). Old preoplc's mentâl funcdoning is labclcd organic brain srndromeor senilin'. Racial minorities, s'hen thev come in contact uiú psvchiatrists,arc morc likclr rhan n'hites to bc given more severe diagnoscs for comparablesvnrpt()ms and to receire more coercirc fornrs of medical social control, suchas pstchiatric hospitalization (Gross er al. l9ó9). \Vomcn, as I sill argue,arc lnore likelç rhan nren ro have problenratic clpericnccsdcfineci and trcatcdnrcdicaiiv. In e ach of rhe se e xamplcs, it is important ro note that üc particular{iroup's economic and social pou'erlessncss legitimatcs its 'protection' bvmcclicrl autlrorities. Of course, ph1'sicians act on behalf of the largcr socieq',ihu: ti:: tl:cr rcinhrrcing cristing pori'er rclarions.

Àliirough nrctl;calization theorv has ernphasized pos'cr, it h:s tendcd ton.':i;rir:;i,rc thc signiliclncc <.riciass. Historicaiii; as i rviil suggest. thc medical-i.'.:,,;: .ij-i'i'i;.;ii':pi',,i,1ç,.,-<.i.rsroott,liã!.tüE-lGTffi. l[i:si.iaíiããã

49

\ledica[zadon is a prardcularll' crirical because it emphasizes úe

ç nor sufEcicnt ior an

illne:s is constructed r}r:ough human actionis rto-t-inheren-t in ani

50 THE SOCIAL CONSTRÍJCTTON OF I'I/OÀíEN'S BODTES Womcn atd Medicalimtiott: A New Perspcctioc

midwivcs who, assisted by a nenvork of female relatives and Êicnds, providedcmotionâl suppoft and practical assistance to thc pregnant l\'oman boú dur-ing the acnral birú and in thc rveeks úat follos,ed. Ovcr a pcriod of more thana centur)','social childbirú" s'as replaced (llhrtz and Wertz 1979). The sitcof cai. siúftcd from the homc to thc hospital. The pcrsonncl rúo gave carechanged from female midçives to mâlc phlsicians. The techniques changedfrom noninterventionist approaches to approaches relpng on tcchnologl'and drugs. Âs a consequcnce, úe meâning of childbirth for somen ivas

tansformcd from a human experience to a medical-technical problcm.A crucial historical juncn:re in úc medicalization of childbirth occurred

in úe sccond dccadc of the nrrnticth cennrn'. In I9I0, about 50 pêrcent ofall rcported birús wcre attcnded by m:driirrs. Thc mcdicd profcssion and drelaity generally belicved úat úe midwife--<ssentially a domestic s'orkcr-s'asan adequatc birú attcndant. Nature s,as thought to control the process ofbirth. Ás a result, úere u'as l.itde to be done in casc ofdiÍficulgr The teachingofobsteuics in medical schools rras minimal, and direct cxperiencc s'ith birthby medical students was raÍe (Kobrin 19ó6).

Bcginning around 19I0, e contest began bcnveen úe emerging specialn'of obstctrics, úc general practitioner, and úe midwife. Álthough seeminglr'about issues ofsciencc and efficaq,, úis strugglc ..r'as also about class and race.

Obstetricians wcre from the donlnant c-!rss, whçreas- midryiyes u'ere-5ap5tl1'

iàmigránr *ã -

Eracr o'ài',in. 3 n" ggi., g,ô diff.r.nãite- úcmsc lr i" fror"general practitioners, obstctricians fought to upgrade the image of their field.They searchcd ficr a respcctable science to legitimate úcir s'ork. Thel' arguedúat normal pregnâncy and parturition \\'cre an excepuon rrther úan thcrule- Bccausc úey believed that birth rvas a pathological process, obstetriciansoften used iügical inten'entions as lr'ell as instruments such as high forcepspreüous to sufficient dilation. These approaches, used routinelv and ofter,unneccssarill', Êequcndy had dclcterious effccts on boú moúer and child.Over a period of mvcral dccadcs, obstctricians n'erc succcssfi:l in persuading

boú their physician coüeagues and úe gencral public ofthe 'fallaq'of nornralpregnanq',' and therefore of the need for a 'science" of obstctrical practice.

Thcir political activitics, couplcd wiú changing<Ícmographic trcnds, resulted

in the dcmisc of midwifcrv (Kobrin 196ó).It is important to note úat úe medical management of childbirth did

not result in grcater safe§'for s'omen, at least in úe short run. Thc evidcnce

suggests that both maternal and infant mortaliry rates actualll' rose duringthe period benveen t9i5 and 1930 u'hen midu'ives'aftcndarrce at tirthabruptly dcclined (Wertz and \Yertz 1979).In the long run, thcre has bccna stcadi' decline in dcaú rates, ri{rich has ctiincided with modcrn chiitibirthpractice . Hôu,ever, it is not clear hos'rnuch of this dccline is due to improvcdenvironmental circumstances and nutrition and horv much to nledicai crrc.

ln light of these facts, 11'h21 slslivaie d u'omcn to go alone ii'itir tlrc mcti -

icalizltion of childbirthi i',ccause chilcil-irth is an event that occurs ri'iihi','.iicon-rrllicàri()ns in m<lst cascr. it is tct'rpiina to cmpiiasizc thi: nl,1n1'los:;ts rir,ll

5l

\l'omcn from the donrinant class joined togcther-albeit out of very differcnt

moti{es*to rcdcfine ccrtain human erents into nredical cât€Borie§' wblcntiom othcr class groups er dmcs enrbraccd and at other timcs resisted these

class-bascd definitions of cxperiencc'

Insum,úenrc+licalizadonframcrr.orkpror,idcsusefulanallticcategonesror.*"rn*i"g úe mcdicalization ofx omcn's problems as a funcdon of ( t ) the

inr.r.r* arrd"bcu.f, of phrsicians; (2) thc class-spccific needs of wornen; and

(3) úc *fit' be§r'ccn úcse, resulting in a consensus that redc6nes a human

à*p".i.n* as a medical problcm. ls itated before, I *ül use this framcç'ork to

;óú.. childbirú [and] reproducri'e conrrol. . . . clearll" bccause of spacc

considerations, it is imjossible to discuss each exâmple in depú. Instead, Ii,of. ,o prortae a frcsh tok at each problem and la1'out the issues as I pcrcci'e

thenr at úis Point.

Childbirú

Todal', pregnancl' and birth are consiciercd oredical eçcnts' This rvas not

.1.,.r,.-.'ihe-crse. Moreor.er, there is nothing- inhcrcnt in either condidon

that nccessita;es routine m.di."l scrudnr'. In fàct, birth is an uncomplicated

f.o..r. in roughll' 90 percent of ca-se1 -fy:*: and \ltrtz 1979)' In order

to unCerstand the medicalization of childi;irth, it must be analyzed as the

;;r;;iri;:"tleoápt." icôiopôlitilal prôcesls iri i'tiich'both ptrv§iiiâLns anc ' -

\\'omen parúciPatedIn mid-ninctcenth-ccnturl' Âmerica, rirruatll' anr'one could bc a doctor'

Às a result, the re §'as ân ot'ersupplv of hcale rs-a series of compering sects §'itil

varl,ing ler:els of training. Thesãlncluded "regular' college-trarned physicians'

phisiclans rrained ty aiprcnticeship, homeoPaths, botanic ph1'sicians' mde

,...oo.h.u,,'midvives,.andothcrhea.ler-s(Drachman1979)'The*rcgu.lar" phlsicians-rvhite, upqcr'class nlales-suuggled to âchi€\'e profe^ssional

domin"".. as boundaries bet*,ecn professiona! and la' control shifted' 1.

is important to cmphasizc that this group sought control over the hcaling

.n,.rprir. ar â dme *hen thc.v,,or. nã, morc cffecti'e rhan their compctitors

incu,ingdistase.Asl-arson(1977)hastroted,thedit.lusionofknorr'lcdgeabour scientific discorrrics in microbiologt'that rcYolutionized medical carc

occurredonll'aftcrmedicincsuccessfullt,gainedcontrolor.erúehcalingmarkcr. Thui, in the absencc ol superior skill, it \1.âs nece§sery to convert

publicperceptions'Inordcrtogain.culturalauthoriq.,(Starr1982)or'erclcfinitions of lrealth and discasc and ovcr thc proYision of healthserüces,*rcgular,' doctors had to transform gctreral hltman skills into tl'reir cxclusive

craft. socia! historians cf mcdicine lra.,'e doc'.rr::ented thc political activities

that succeeded in guaranteeing a cl<;scd shoP for *reeular" doctors in late

nincteenth- ,nd "r.ly

rventictli-ccnttlr' Amcrica (lkrcrbv antl Rosner 1979;

\\illSll lv,/ / J'

 ccntral arcni tirr thc strrrggic l:r'cr llrtlilssi'Ll'i'ii .ioi-lrii'iriiicc §'as chilci-

t,il.tir. ir, tttktni.ri Ântelica, tlrir..'.,.,1 \1":.: hrtrr.iicij irÍcri':r,i'!iil.rilti'r' ll1' fsfi.!'r1c

52 THE SOCTAL CONSTR UCTION OT II/OMEN'S BO D I ES

accompenied itsmcdicalization. In modern birú, thct'onran is removcd komfamiliar surrouadings, from kin and social support, and subjected to a scries oftcchnical procedurcs-many of 'n'hich arc de humanizing and oúcrs of s'hichcarry significant hcalú risks (Roúman 1982; Sharv 1974). I rvoman's expe -

ricncc of birú is dicnated bcc-';c the social rclations and instrumentadonof úe mcdical setting remove hcr control orer the experie nce (Ibung 1984).Bccause ofthesc ncgativc conscquences of modcrn birú, úerc is a tendeno'toromanticize úe midu,ifc and pretechnological childbirú and fail to considerúe contradictc,ry naturc of the process.

Womcn participatcd in úc medicalizauon of childbirú for a complex set

of reasoru. First, nineteenú-ccnru4'women rvanred freedom from thc pain,cúaustion, and lingering incapacitl'ofchildbirth. Pregnanq'errr,v oúer year

was the norm for married \vomen, and this took a significant toll on thcrcproducti're organs. Conuaception was not a riable alternadvc, for reasons

I will discuss shortly. For rvorking-class t'omen, úe problems of matcrniq'wcrc intcnsificd by harsh working and housing condirions. The lencrs ofearly tt'enricth-ccntuq's'orking class rvomen vividlv portral' the exhaustionof moúcrhood (Davies 1978). Àlbcit for diÍterent reâsons! rvomen fromdiffercnt class groups cxperienced birth as a terriÂ'ing ordeal (Dte 1980).

In thc carl,v decades of úe nventieth cenrur\; relief fronr the pain ofchitdbirú rvas promiscd wiú 'nrüght sleep," a conrbintion of morphine

'"': '- ' 'ãnd scàpo!ânÍrtdrvhích-Europc-âÍr'phJ6'iciâÍrsttadtêgun"to usel Historical -'analpis of úe nrilight sleep movement in thc Llnited States reveals úatir rvas rvomcn rvào dcmanded it. Êequentlv pitting thcmselves against dre

mcdical profession who both rcsentcd iay interference and Íeared thc dange rs

ofúc drug (Lraviu 1980). Thcsc somen-middle - and uppcr-class reformerswiú a progressirrc ideolçg-1,-11'anted to alter úc oppressive circunrstances of

i women's livcs. Thus, úe demand for anesúesia in childbirth rvas part of a

largcr social movcment. Prcgnanq'rl,as no longer seen as a condirion to be

. cndured u'ith faulism and passiviq'(Smiú-Rosenberg and Rosenberg 1973).As Miller (L979, ar€iues. people bclieved úat citilization had increased úesubjectivc expcricnce of pain in childbirth, and rhat ancsthesiâ s'ould once

again makc childbirth natural. The upper class experienced greater pain úan*'orking-class §icÍncn, s'ho rrere úought to be morc like prinritive peoples.

Pcople bclio-ed that uppcr-class womcn had been pardculady s'atped b1'

cir.'iiization. (Thc corset also mav have distorteci their inrcrnai organs.) Inoúer rvordso pain had accompanicd the progress of civilizarion. If frced frompainfut and crhausting labor, \l'omcn could (thc rcfornrers felt) nrorc futl1'participate in democradc socien' ( Millcr 1979 ).

Sccond, because of declining fcrtilitv in upper- and nriddle -ciass l\'omenat thc end of úc nincteenth cenrur),, thc mcaning of birth ivas particularll'significant to thcm. Because childbirth rvas a lcss fiequcnt cvcnt) concernabout íctal death was grcater. In addition, \\'onrcn scrc ÍiarlLri lrccause itwas comnron to have knorvn somconc u'ho hrii t'lied in clriltlbirth (Di'e1980). Thus..r'e!l-to-do il,omcn rvanted to bc atrtnC,:d !...'iiocicrs not

Ílbun and J{tilicaligttion: Á Nw Pcrspeetitrc

onh' becausc üei' rrerc of higÍrcr social starus compared to mid*ives butalso because ther possesscd úe instruments and surgical techniques úatmight be bcneficial in cases of prolorrged labor" toxemia, fctar disticss, andoúer abnormal conditions. of course . phr:icians used thcse fears to gainconuol over the entire markcr. includine routine births.

Thus, the demise of miduiter'and the resukanr med.icalization of child-birú t'ere consequences of tbrces s-iúin üe rr-onten's communin, as rvellas from outside ir. Furúermore, ir *'as a class-specific process. llUl-to-dolr'omen §'anted ro reduce rhe control that biologY had ovcr úeir lircs. Theyrranted freedom from pain. Bccause of úeir rcfincmenq mcdical ideologyof the period insisred úar n'ell-do-do \\-omen llrre morc delicate ald hencemorc likely to experience pain and complicadons. Bv contrasr, *orking-classll'omen rvere belie.ed to be inherentlv stronger (con 1972). pcrhaps as a*'a' of resisting úese idcological assumprions, *'ell-ro-do \\'omen ivantedconuol o'er rhe birüing process-úe nght to decide rúat kind of laborand delirrrt'úer s'ould hare. The contradicrion rr.as úar úe method úese\r.'omen demanded--eoing to slerg-put üem onr ofcontrol (Leavitt I9g0).

Obstetricians also u'anted conrrol. Thev bclicred that birth u,as a paúo-logical prrxess and úar 'sciendfic birth" *ould resuk in grearer safãn. foraffluent \\'omcn esper-iallr. h addition, ir *'as in lhe interest of phvsiciansto caprllre the childbirrh marker, because úis event proüded a garewâ\,to

' úe-famii1,,-and-hcnce .thc 'entirr àealkrg rharlret-ílVertz erid Utftz -lg7g)'.- -

Phlsicians wcre pardcularlr aruiious to attend rhe birrhs ofurll-to-do *,omen,because the social starus of úcse \\omen lent legitimao'and respectabilin,tothe shitt írom mid*'ittn' to obstetrics í Drachman L979). rn order to controlchildbirth, phvsicians needed drues and tcchnologt' ro appcar indispensable(r\Íiller 1979). Theret-ore, rhe'*cn! alons x'ith nr.ilight slcep, ar leasr tbr a

time . The iron' for \\'omcn *'as úar üis approach ro thc pain of childbirthserr-ed to distance llomen from úcir bodies and redefinc birth as aÍl c\.entrequiring hosp:talization and phlsician artendance (Leavin 19801.

Currentl'r; úe medicalizarion ol childbirth is taking neu' fornrs. First,therc is the strikinglt high rare of cesarean delilcries-2I.2% of .{mericanbabies as of- 1994 (\tntura et al., 199-1 1. Although sonre ofthcsc are necessar)rfor maternal health as rvell as infanr sunital, er{dence suggesr that manycaesarcans are unnecessârr (O'Driscoll and Folet 1983). In r.ierç of medi-calizidon, it is important to point out that thc potcntial need íor â ccsarcanplaces childbirth squarel.r'and e:iclusivelt in the hands ofthe phvsician. Vaginaldclilcn; bv conlrast, c:n be üe protince of nonphtsiciân crperts, such as

nursc - nr id s'ives.

Scccrnd, there is a rrend to nrake the birtl'r e.tpcricnce morc hunranc.for both nrothcr and babr'. Hospitals are devcloping *birthing rooms" andother rltcrnati..es to the usu:l dclivcrv Ícoilr âtiiiosphcrc of stcci t:rLrlcs,stirrui.s, anci brigàt lights- .{ficr birth, marcrnai-intinr c()ntâcr is pcrnrirtcciso as ii) fi;,ster "bonding." I)cdiarriciens bclicvc th.rt: critica! pcrioci cxisls Íbr'tht dcr'11r.'1-.111cnt oi;rit opiii:irl rcl;rrionsl'rio bcnrccll rrrorlrci-:;tii ;:crrirol't

53

rHE SACIAL CONSTRUCrION OF WOMEN'S BODIES

Re-p-rodgçtlye §reedpm

llToncn and X{cd.icolizaion: A New perspcctit c 55

(Klaus and Kcanell 19Z6). Thus, pcdiatricians arc joining o stcuicians innredicalizing úc childbirth exp:ericncc. By dcfininj rvhJ should be (andthcrcforc u'har is) de'iant, pcdiaricians crearc social-norms for parerrting.

Thc contradiction isthat thc rccenr changes in úe hospital enuironÃerrtof birú have boú helped and hurt *'omen. nirtrring ro.msand earll,contactl'rnr-ecn rnoúer and nervborn arc a *,elcome changãÊom previous oppressi'cobsteuical and pediatric practiccs (r'hich poor womcr,,ti[ f"c" bccause thesereforms are more characteristic of cüte hospitals than of public oncs). yerúe contemporary feminist critiouc of childbirth practicc has bccn cur shorrb1' úcsc reforms. As in mant' reform *orra-a.rar, rarger issues arc silenced.challenges to úe medical dominadon ofpr.gn*q'*ã demands for genuinedemedicalization have becn co-opted by an exclusil'c focus on tti" uirtt,en*ironmcnt. Even s,hcn'narurâl'childbirú occurs in birthing roon:s, birthis

still d9fined rnedicalll', is srill under úe control ofphrsicians, a-nd still occ,rrsin i-rospitals (Roúman t98l).

ÀÍoreo'cr, thc social meaning of parenting changes *àcn scientific ratio-\nales such as 'bonding' and "artachment' arc uscdio justify moúers being I;rear-ücir babies after gi'ing birth (Ârney l9g0). In additián, ,.* .o1.. ,r! hreinforced *'hen it is moúers and not faúers who need ro be ..bonde.l,' to ítheir infants. )

ph1'sician *'arned rhar aborrion rvas bcing used .ro a'oid the labor of caring ,for and rcaring children' (Si.lr.cr as q,rotid in Mohr l97g). Io ".h;;;;:,\1'ômen *'cre shirliing úe responsibilidcs of úcir seemingh, biologicallv da-termrncd rolc-

. À{ohr (1978) argucs úar physicians led úe moral crusaC- rgainst abor_tion not so much our of thcsc antifeminist fecüngs, but primaily il;;J;,to restrict úc practice of mcdicinc. The' wanrcd to g.t .id

"r."-p.uio..('irreg,lars' and *docrresscs') and gain a monopoly ov-er th. p.r.,i..ãirn.a-icine. 81- alte ring public opinion and pca*ading regirr*""r, ,r,." ,u....à.a i.,establÍshing úeir codc of eúics (rvhich spccifically excludea.u".u""iãrã.basis for profcssional practice. These acdons limiied úe scopc

"rn .á.iJ.

compe-ti-tors, espcciallt' ..'omen doctors s'hose practice, ,.,ara do,ot a ao ,t.care.of female complainrs. Br úe rate 1870s, anti-abortion staruter..".. à.r-.the book- Professi.nar dominance *,as furúer strengthcned in the lgg0; ç*'hen phlsicians became more organized. They used tÁe scientific prr.aiil )to force morc and more Íblk practitioncrs frorn úe ficld.

prospcrous families

ITI(,VCmem:\l.Omen tô

for rhc anti-abonion

Abortion

Todai, aborrion is treated as a medica! e'ent. yct in previous historical periods,ir *as defined in nonmecical terms. phyricians bràught specific proàssio'aland ciass inrerests to the abortion issue in úe nineteãnúi..ra,rry. To realizetheir intcresa, the1, needed to aher public belieG abour úe meaning ofun*'anted prcgnanÕ'|. \Yell-ro-do §,om.n formed 3'' rili21ç6 wiú doctols lnthis redefinition process because of their ou,n need.s.

- Às Mohr ( 1978) documents, abortion before quickening (úc perceptio. 7_of fetal mo,ement) *,as *,idcl1'practiced in thc mid-nineteãnü.inturu "rrd

§\l'as nor seen as morally or legalh'\l.rong. Inforn:adon o., potions, purg"-úr'cs, and quasi-surgical tcchniques *'as a,ailabrc in home medical rn*udr.Âs autoaborti'c instrumen$ came on dre market, \\'omcn became skillfulin performing úeir o*'n abordons, and they sharcd information wiú oneanothcr- In addition, midnives, herbal hcalers, and oúer *kregular, doctorsestablished lucrative practiccs in rhe trcatment of *obstructeá menses.,, ltis estimatcd that b1' 1878 onc in fir'e pregnancies *.as.inrcnrionally abortcd.The growing frequencl,of aborcion *'as particurarl* evident in the middie a,tlupper classes (Mohr i9Z8).

. iRegYl,ar" phi'sicians u'cre central figures i@

,".lrt , ,t.1rate, espcciallij amonq the middle and ugrper classes ri'ho fcarcd tút tiri-.coulci lcaci rcr "ract:uicidc" (srlirh-Loscni:crg anci Rosenbcre 1973). onc

1\'e re concerned úar the uppe r classes *'ould be outbred. Finall1., úã conflicibet*'een úe "regular' ilóctors and their competitors ,*,", no, onlr. aboutissues of science and proÊssional conuor but also about the issues'of classand patriarchr The *irreg;,lar' doctors *.ere, in gcneral, not from familiesof the dominant class. In addition, these practitioners wcre morc likelv to befemale. Thus socia! characteristics proridcd thc rationalc for exclusion, furthe.reinforcing patriarchal class relations.

womcn's parcicipadon in úe anti-abortion crusade of the lg70s also *,asclass-specific. Feminisu of thc period-r'eil-to-do \1,omcn-*{amc our against .abortion, arguing instcad for *oluntan, motherhood. Thcse carly fem"iniss )recommcndcd periodic or perrnancnr absdnence as methods of biith cont.ol Ibecause they di,C nor approle of contraceptive devices (Gordon 197ó). I

It is ob*ious thar *'omen lost significant Êcedorns *'hen abortion rvasdefined as a mcdical procedure and ruled illegal. yct, from the perspectir.e oft!9 q}ual- qolitics of iate-nineteenth-century Ánüriôi;it is ;i;niÊiür ihar "

}]:*rryT.S=1ry"õvêi-âtiôiüoã. Ãt»aneriõã-\ã§-á-mõô ?ãaiõãl* .7rcsponse to thc po*críé1rríõriíiri-tfiãF-âiãa-rchal family than a pro-abortionstance s'ould hrvc becn. :

\.!ci.l-to-do \1:oincn of the latc nincteenth centurv had a ic*el of hostilin,to*'ard sc-x, both bccru:-c ir brought un*'a'ted ancl danqerou, pr.gnrna,._,,.'and becruse ir *es : i.slijl" pll_'_:li]::,{.::titl,"gg§: Evr:n more in,párt.,.,i,

!t is intercsting ro notc úe social relations at

5ó THE SOCIAL CONST?.{JC'fi ON OF I{/O,IíEN'S BODI ES

Gordon ( 197ó) argucs that these rromcn resented the particular kind ofserual

encounter úat u'as characteristic of .l.merican Victorian socien': intercourse.

dominated bi the husband's nceds and ncglefiing rrhrt n'light bring plersurc

to a \\,oman. À{en's style of lovcmaking repelled \\'or)ren. Thct fàlt that men

rvere ovcrscled and violent. Furthcrmore, because men fi§ited prostitutcs,

marital scx for \\'omen nor infrequenrli' rcsr.rltcd in rcnereal diseasc. upderúese conditions, â woman's right to rcfrrse §'as ccntrâl ro her indepcndence

and personal integrity.In sum, the tcrmination of ân unl1?nted Pre

qnrncY underwcnt a series

of changing definitions: ir §'cnr from a human problcm to a topic of medical

concefn ro a crime . with úe 1973 Supreme Courr dccision [in Roc rr Wade],

it rvas remedicalized, but this timc u'ith the support of the medical profession.

Physi6i*t no longcr needed this issue to advaoce dre ir sovcreignry.

Contr&ceptiorl

í tr ,1. §\'entieth centur\') *'ell-to-do \l'onlen joined phlsicians again in the

I rncdicalizaion of reproduction l'irh rhe issue of contraception. These \\'ornen-suuggle.l to define a "netr se nse of \1'omanhood'o dr;rt did nor requirc sexual

passi\1n', materniq', domesricin; ând tlie ab§ence of anrbiuon. In order to

achierr these goals feminists oiercame úeir scruples agâinst artificial con-

- --t 4çepdon. trrnporandg §'ome$.ultilBately-r1o8 S.e bamie of repro{-uc-tite. -

freedom. Tecl.rnolory to limir famiil'size §,as developed in response to the

social demand for it (Gordon 197ó).

f But as s'omcn gaincd fiom this nes'l)'rvotr independence, thel' also

(_ torr. Birú conuol tcchnologY is nor $'iúoüt problen'rs, both in its female

centricin'and its risk. Furthermorc, as Gordon argue§, thc professionalism

and mcdicalizarion of birú contro_l strippc$ ir_gjit*ry!1!§"1:gJg!! .§'

a result of its dcfinition as a healú isiúê, ãontraccpdon bccanie sônrervhat

'. rrr-rEãI§içÍftF Il§ 9.,Ftg;&g.íir* conrot irf*ç ilqlpUgiEnal\i thc bánle orcr medicalization *'as lost

@ods rvent in the dircction of high tcchno.logr'.

The piil, úe IUD, and injectable conrraceptivcs ere fore\.er in the hands ofmcdicinc. because âccess to thcsc drugs and dcticcs is legally controlled. In

conüast! úc lorç-techlology barricr nrethods-tlre condom, cerl'ical caP, or

diaphragn'r-require lirtlc mcdical intcrr"ention or conftol-These historical cxan:plcs underscore the tàct thàt t1.on:en's cxpcriencc

u.as a site for the initial mcdicalization effort. ÀIcdicine *staked clrrinrs" for ''

childbirtlr. aborrion, arrd birth control and secured thcnr as "medical turF bv

altering public bclicfs and persuading the statc of th.: lcgitin'racv of thcir clainr

(cf. Conrrd and Schncidcr 1980a). Phlsicians uscrl scictrcc âs,tl'rc rationaic for

profcssiorrll dontinanÇe - Âs I lr:rve suggcstcd, riot:tctt's participation in tl'rcrcdcfinirion of caclr cxPcrirrrcc s'as tlrc rcsult <lf cor:rPlcx [ristorical :rtrd chss-

spccific nrorivrs. anri tircl rrr)r <rnlr'Írained lrut losi rlith thc nteclicaiizatiotr oi.,^ ^t. ^ -., .

llbmen and Jkiic'zli:ttriox: A Nca, Petspectipe

The Fit Bct§'een W'omen's Interests and phl,sicians, Intercsts

Thcsc examplcs illustrarc a qcneral point about mcdical social control: úereare rimcs s'hen the inte resrs of rrome n tionr úc middle and upper classes arese^ed bv the thcrupcuric protissions, u'hose political and cconàmic intcrestslre in turn sen'ed b'trunsf-ornring drese rr.omen's complaints inro illnesses.In oüer *'ords, both historicalll and currentlr,, rhere has tcndcd to be a -fit"benr-een medicine's intcresr in erpanding irs jurisdicdon and úe need of

\lhile nece ssân', the pardcular interes$ of *,omen and phr.sicians do notalone explain üe erpansion of the clinical domain. oúcr iommunides alsoinfluence *'har occurs in the doctor's office. In úe context of a capitalisteconomv and a technologicallv donrinated medical care s),stcm, large profitsaccompan)'each redefinition of hurnan cxpericnce into medicat terms, sincernorc cirugs, tests, procedurcs, cquiprnent, and insurancc co\ erage arc needed.Ás mentioneci betbre, specific medica! indusriés harr plal'eôa direct rolcin influe'cing boú phvsicians' and r'omen's percepiãor of rcproductirecontrol, premenstrual §'ndrome, and 1. eight. yet it is impcrtant tolmphasize-ti,aprgrpggagionr,-in heir-cttbrt to-maxltrize p.o6ts; welrk tbrougb-boútphlsicians and s'omen.

Implicit in mv analvsis is rhc assurrrption that *,omcn's experience hasbeen medicalized more rhan men's. Yet it could bc argued instead rhatmedicine has encroached into mcn's lives in a ditlàrent but equal làshio'.For example, medicine has focused on childhood h'pcractir.in.and rhe adultaddictions-problems more conrmon in malcs than females (Conrad andschncidcr 1980a). occuparionrl n-rcdicine has tcndcd to focus on male jobs.In pardcular, 'stress managemcnt' programs are targeting male execui,,es.Ho*c'sJ, *'hile not to diminish thesc eramples, I believc úat *'onren's li'eshar"e undergone a morc total transfornradon as a resurt of medical scrutiny,.lÍedicalization has rcsulted in thc cor.'srruction ofnredical meanings of r wnts.lfunctions in *omen----cxperienccs rhe n,pical \l,oman goes through, such asmcnsüuatiorr, reproduction, childbirth, and menopause. Bt contrasr, roudnce xpe riences thar are unique!r'nrrle rrmain lrrgell'unstudicc br mcdica! scitnceand. conscquentll', are rarch'trcarcd brphrsicians as potentiall'patholoeical.For exanrple, male hormonal cvclcs and the male climactcric ren:ain lrrscrvunresearchcd. Less is kncr'.'r at,out thc male reproductive svstenr than aboutthat of thc Íe male . Male ccrnrraccptii'c technologl' rags far be hind riret isavailablc for s'es1çp. Baldncss in nrcn has not Yet becn defined as a ntcdicalcondition nceding treatmclrr, c'cn though an industri,cxisrs to rcnrcdv thcproblcnr of hair loss. Mcn's p.5i.çi,,riogical livcs irar.c n<;r bccn subje ctcc topslchiatric scrutinv ncarll' t. rhc de {arcc that \r,(}ileil's ci:ioti<-rr-rs ira'c brcr.rstudicd. As a rcsult. nralc vioicrrit. nted Íirr psr*.,ri'. rnd <;i'crruionr.iirr,?.rr iroi

§-omen to hare úeir experience ackno*1cdged. I ha'e emphasized that thisn tcrJsion-frlled and fiaueht s.ith conradictions fcr s,omen, rvho

58 TH E SOC T AL CONSTR UCTION OF IVOMENT BODIES

dcfined as pathological conditions. Perhaps only imporence has been subjectro drc same dcgrce of rnedical scrutiny as wonten's problems.

\\/hv has rvomcnns cxpcriencc bccn such a ccntral focus for medicalizationlIn addirion to thc complcx motites úat x'omcn bring to cach particular healthissue, ph1'sicians foctrs on \r'omen as a prinran' market for expansion for a

nunrbcr of reasons. First, thcre is a good match bct\r'ecn \l'ome n's biologtr, andmcdicine's biomcdical orientation. External markcrs of biological processes

crist in $'omcn (rnenstruadon, birth, lactation, and so forth), u'hcrcas úc1'arc more hidden in n'ren. Given modcrn medicinc's biomedical oricntation,úcse external signs makc \\,omen easy targcts for mcdical encroachment. Aditltrcnt medical paradigm (one that vierved heahh as úc conscqucnce ofharnrony bcts,ecn úe pcrson and úe environment, for example) might havehad less basis for focusing on \l'omen.

Sccond, n'omen's social rolcs make them readill'available to medicalscrutinr'. Women arç more likelr to come in contact's'irh nredical providersbecause úey care for children and arc the 'kin kecpers" of úe family (Rossi

1980), In concrete terms, rvomen are more likcl,v ro accompan)t sick childrenand agcd relatirrs to the doctor.

Third, ri,onren harr grcater exposure to medica.l labeling because of úeirpârte rn of dealing t'ith úeir o*'n svrnptoms> as t'ell as medicirre's response toúat panern. \lbmen make more visits to ph)'sicians than merr, alúough it isnqt-clc3r_rúcrher-this is due to $c rgçd]c{iz.arioo o{ú.eir biolosiç41E+icgons: -'rcal' illness, behavior lthen ill, or cultural expectadons (Naúanson 1977).l\trcn thev visit the doctor for an1, serious illness, úe1'are more likel1, $q1nlen to be checked for reproductire implications of the illness. They are

nrore subject to regular check of thcir reproductir-e st'stents, in úe formof vcarll' pap smears or rynecological exams. Importand-v. u,henever úe1'risit úc doctor úere is evidencc that drey receirrc more total and extensivese rtices-in úe form of lab tests, proccdures, drug pre sciiptions, and returnappointrnents-ttran do mcn s'ith t}e same complaints and sociodemographicrisk factors (Vcrbrugge and Stcincr 1981). Thus, a q'cle of greatcr medicalscrudnl' ofs'omen's cxpcrienccs is begun with each risit to the docor.

Finalll', tvonrco's structural subordination to men has madc them par-

ricularl,v rulnerable to the €xpânsion of úe clinical domain. In gencral, malephlsicians trcat fcmâle padents. Social relations in the doctor's officc rcplicateparriarchal relations in the largcr culture, and this all procccds under theguise ofscience . (Patriarchal control is most evidcnr s'i'le n ph1'sicians socializetoung \1'omcn regarding appropriate scxual behavior, pcrhaps s'ithholdingcontracepdve adricc, or lecturing them about thc dangers of promiscuiry).For all these reasons, it is not surprising that u'omen ârc more subject tomeciicai dcfinitions oltheir expcricncc thân mcn arc. in thcsc n'ays, dominantsocial interests and petriarcha! institutions are reinforccd.

,{s a resu!:, \\'onrerl are cspeciallv appropriate nrarkcts for the expansion

oímedicinc. Thcv are suitablc biologicall-v, sociallr', anci 1.rs','ciioiogicaliv. Tircnressage that t'onrcn are cxpcctcd to 'oe de1.-en.icni ,.;'i: r':r:11{ ph1'sicians to

Wuten ard Mcdic*lization: A Ntw Pcrspcctile

manâgc their livcs is rcinforccd byúc pharmaceutical industrv in drug adver-tisernents and by úe mcdia in gcncral. Yct it is far too simple to poruav thecncroachment of medicincs as a coospiraq'-by malc doctors and rhe *medical

industrial complcx'-to subordinate \\'omen further. Àlthough somc haveargued úat mcdicine is úe scicntfic cquitalent of carlier cusroms like mar-riagc lats and kinship riruals úat conuollcd \\.omen b)' conuolllng üeirsexualiq', srrch an anall,sis is incornplete. fu I havc stressed, mcdicalizationis more than what doctors do, al*rough it may bc úrough dcctors thar theintcrests of oúcr gÍoups are oftcn realized. Nor docs a conspüaq úcorl'explain n'h1,, for úc most part, \r'omen from certain class groups havc beenwilling collaborators in úe medicalization process. Rathcr úan dismissingúese s'omen as odupcd,' I have suggested some of úe complcx motives úathave caused certain classes of n'omcn to participate uiú phrsicians in úeredefinition of particular expcrienccs.

In addition, a conspiraq'theory does not explain th-v medicalizarion has

been rrrore virulent in some historical periods and in some medical specialtiesthan in others. For cxample, g.rnccologists initialll, trir"ialized menopausaldiscomfori, only to reclaim it iater for ucatme nt [as premensuual syndrome ].At úe same time úat g1'necologists rrerc unwilling to acknos,ledge úelegitimacr of rvomen's complâints, the developing specidn' of ps1'chiatrl'

moved in xith thc pq,'chogenic account. I have argued úat these shifuand interpr?fçssr.onal ú'{riç§-o;'cr -tqf u-e çryI4|lgd by qqtçrnal igggçs. façingeach sp:ciaIry at particular poinu in histon'. Thus, an anaivsis of üe marketcondidons faced b1'phl,sicians in gcneral, and certain spccialdes in particular,is ne ce ssarv to cxplain úe varf ing 1çsporrse of medicine to s'ome n's problems.

Furúer research is needed to caprure more full1'the historical aspect ofthese shifis in medical perccpdon. Such an anallsis nceds to focus in dcpthon speci§c events in tt'omcn's erperience and trace úeir mcdicalizadon inhistorical and class context: thc issues brought in turn by'groups of uc,men,

by the particular medical spccialies, b1' úe pharmaceudcal industrl', and bythe *fit' betu,een úese úat resulted in a rede§nition. A conspiraq' úcorl'fails to capture the nuances of úis compler Process.

Conclusion

The medicalization of human problems is a contradictorv realin' for s'omcn"

It is part of thc problcm and of úe soludon. Ir has grosn out of and in turnhas created a series of paradoxes. As rronren havc tried to free úemsclvesironr thc control that biological processes have had otcr úcir lives, thcv

sir-nuitaneousll, have srrengthened thc control of a bion'redical vieu' of thcirc:ipcric;icc. As t'cr:'lc;.i

"'isit doctors alrd {ct syn:ptom re lie f, the social causes ctf

their problcms are iqnored. As doctors acknorvledgc rvonten's expericnce and

trcat thcir problcrns medicallr', problcms are strippcd oitiieir political cootent-:,r,i n.'!r,,1)r n11\r-.-!.enrs are takcn o..',:r. Bccause <.;Í' rhcsc contradictions,ivi)irci-i lll JiÍ]c;-c:.ir ciiss;rositions llaic sriusltt and rcsistcd rncdicai control.

59

*rír. f:4i.rr.-

60 THE SOCTAL CONSTRÜCTION OF WOMEIi-'"S BODIE5

I havc argued that the transformation of such human expcrierrccs as

childbirth, reproduction, prcmenstrual problems, *'eight. and ps1'chologicaldistress into mcdical cvenc has becn úc outcome of a rcciprocal proccss in-volving boú ph1'sicians and r1'omen. Àdedicine, as it dereloped as a protcssion,t'as repeatcdh' rcdcfined. The intcrest of phlsicians in expanding juristiictior,

into net, areas coincidcd riirh the interest ofcertairi class groups in lraving rheirexpericnce in úosc areas undcrstood in nes'terms. In other sor,Js, phvsicianscrcatcd dcmand in order to gcnerate neu'markers for úeir sen'ices. Thcv also

responded to a markct rlat a class of somen created. . . .

Âs Conrad and Schneider ( 1980a) note, úe potcndal tbr nredicalizadonincreases as sciencc discovers the subde ph1'sfological correlates of humanbehavior. A s'ealú of knou,ledge is dcveloping about t'omen's ph1'siologr'.Âs more bccomcs knos'n, the issue u'ill be hot'to ackno's-1et{ge the conlplerbiochemical componcnts üat are related to menstruadon, pregnrncr', seight,and the like *iúout allos'ing úese conditicns to be distorted bv scienci6c

understanding. The issue s'ill be to gain undcrstanding ofour biol.;gl; uiúoutsubmitting to control in úe guise of medical o'erperdse -" The anss'er is

not to 'suffer our fate' and rcturn exclusivell'to selt:care. as Illich \L976)recommcnds, úereb1' tr,rrning our backs on discoteries and trcatrner-1ts lhatma)/ câse pai;r and suffering. To "demedicalize' is not to denr rhe biologicalcomponents ofexoerience but rather to alter the os'nership, producdon, andusc of rcicntific knos,iedse. . . .' in süni, ri'6mán's'h"eaittL ii ficed Lt a ieriês'oT'.:halleirges. Í\t-neêdto expose úe *uuú claims" (Biuner I9ó8) of medical entrepreneurs u'hos'ill seek to rurn ne\i' areas of experience inro medical ele nts, and irrstead

intrcdrrce a healthy skepticism atrout professional .1"1n15. llt nccd to developalternadves to the m$cul.inist biomedical tierr'and placc u'orrrcn's hcalúprotrlems in úc larger context of úeir lives. Specilicalh; it is not at âllclear rvhat form pregnanq', rnensffuadon, s'eight, xrualiq; aging, or oúerproblems u'ould take in a socieq' 'that allou,ed \1omen to nornrallr androudncl.v eripress anger, drive, and anrbitiorr, a socierl in rrhich *'onren teltmore cmpo\r'ered' (Harrison 1982). \\re need to recon(cprualize our u{role§'a). of thinking about biologl' and erplore hou, "natural* phcnontena are,

in fact, an outgroll'th of the social circumstanccs of rtonrcn's livcs (Hubhardr98 r ).

In the meantime, because t'e *'ill continuc to necd hcaltlr carc, thechallenge uill be to alter the tcrms under rvl'rich care is prorided. In theshort te rm, s'c necd to u'ork Íbr spcci{ic reforms arrd eein shat n c can u'hile,ar the same dme, acknou'ledging thc lirnitation olretbrnr- .\s I irelc argucd,reform is not rvhat \\'c \\'ant in thc long run. For ccrtain problcnrs in ourlivcs, real de medicalization is neccssa:'.,; e rpcriclccs such as rc'.ttinc childbirth,nr€nopause, or srcight in cxccss oí cultural nornrs shoul.l rtot be definedin medical terms, ancl medical-tcchnical trcrtnrer:ts shorrid not lrc sccn as

e1;propriate solutions to thcsc problcnrs. Frir otlrcr conciitions v,'hclc nrctlicincnrav bc of assistancc, rhc chrllcnce r.'ili i-.,: to riiijcrci-:ii:ic tirc ircncficial

lAonq» nnd ][ttlicalization: A New Pctspcctive

ueârmenrs trom those that are harmful and uscless. Thc rcal challengc is

to use eriisring medical knos'ledgc sclcctir"cl,v and to extend knon'ledge withnet' paradignls so âs to improre thc qualin'of our lives.

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