ON GOOD AND BAD FORMS OF MEDICALIZATION ERIK PARENS Keywords medicalization, normalization, enhancement, bioethics ABSTRACT The ongoing ‘enhancement’ debate pits critics of new self-shaping tech- nologies against enthusiasts. One important thread of that debate concerns medicalization, the process whereby ‘non-medical’ problems become framed as ‘medical’ problems. In this paper I consider the charge of medicalization, which critics often level at new forms of technological self-shaping, and explain how that charge can illuminate – and obfuscate. Then, more briefly, I examine the charge of pharmacological Calvinism, which enthusiasts, in their support of technological self-shaping, often level at critics. And I suggest how that charge, too, can illuminate and obfuscate. Exploring the broad charge of medicalization and the narrower counter charge of pharmacological Calvinism leads me to conclude that, as satis- fying as it can be to level one of those charges at our intellectual opponents, and as tempting as it is to lie down and rest with our favorite insight, we need to gather the energy to have a conversation about the difference between good and bad forms of medicalization. Specifically, I suggest that if we consider the ‘medicalization of love,’ we can see why critics of and enthusiasts about technological self-shaping should want (and in some cases have already begun) to distinguish between good and bad forms of such medicalization. I too believe that humanity will win in the long run; I am only afraid that at the same time the world will have turned into one huge hospital where everyone is every- body else’s humane nurse. Goethe 1 It can be appropriate to use medical means to prevent suffering and enhance well-being even if the source of the problem is not a disease. Laura Purdy 2 For the last thirty or forty years, sociologists have used the term medicalization to refer to the process by which ‘non-medical’ (or ‘life’ or ‘human’) problems become understood and treated as ‘medical’ problems. 3 Of course social scientists typically understand themselves to be describing – not evaluating – social processes. Indeed, one of the fathers of medicalization theory, the sociolo- gist Peter Conrad, has stated more than once that the term medicalization is value neutral. In his recent book he writes: ‘While medicalization describes a social process, like globalization or secularization, it does not imply that a change is good or bad.’ 4 That assertion notwithstanding, when sociologists use the term medicalization, they have traditionally assumed that the process it names is bad. In this paper, I will suggest that we in bioethics should not make that simpli- fying assumption, but should instead do the complex work of attempting to distinguish between good and bad forms of medicalization. 1 Quoted in P. Rieff. 1966. The Triumph of the Therapeutic: Uses of Faith after Freud. New York: Harper & Row: 24. 2 L. Purdy. Medicalization, Medical Necessity, and Feminist Medicine. Bioethics 2001; 15(3): 248–261, at 258. 3 P. Conrad. 2007. The Medicalization of Society: On the Transforma- tion of Human Conditions into Treatable Disorders. Baltimore: The Johns Hopkins University Press: 3–4. 4 P. Conrad, T. Mackie & A. Mehrotra. Estimating the Costs of Medi- calization. Social Science and Medicine 2010; 70: 1943–1947, at 1943. Address for correspondence: Erik Parens, The Hastings Center, 21 Malcolm Gordon Rd, Garrison, New York 10524 USA. Email: parense@ thehastingscenter.org Conflict of interest statement: No conflicts declared Bioethics ISSN 0269-9702 (print); 1467-8519 (online) doi:10.1111/j.1467-8519.2011.01885.x © 2011 Blackwell Publishing Ltd., 9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main Street, Malden, MA 02148, USA.