Liam Marshall reflects on the limits of contemporary medicalisation scholarship which can de-historicise enduring modes of power.
Medicalisation- referring to the expansion of medical jurisdiction and the incorporation of increasingly diverse aspects of social life into medical practice- has emerged as a prominent theme in the contemporary social sciences. Historically, literature on medicalisation derives from two overlapping but distinct intellectual currents: one foregrounding the medicalisation of deviance, and the other focusing on the expansion of the medical realm itself. Scholarship on the medicalisation of deviance builds on critical genealogies of health institutions, most notably in the Foucauldian tradition, presenting the medical realm as a distinct site of social control (e.g., Schneider, 2015). Alternative medicalisation scholarship traces the expansion of the medical domain over time, utilising empirical methods to study health behaviours and infrastructures, heavily influenced by the sociology of medicine (Sholl, 2017).
Contemporary scholarship on medicalisation is closer to the latter approach, drawn from the sociology of medicine, but with a neoliberal inflection. Moving away from broader analyses of power structures within the medical realm, it focuses on medicalisation as a growing phenomenon under neoliberalism. While current literature has greatly expanded understandings of the social impacts of medical regimes under neoliberalism, here I argue that centering neoliberal regimes so extensively has constrained this literature from engaging with deeper analyses of medicalisation. Current scholarship often presents medicalisation as a distinctly neoliberal phenomenon, occluding broader historical and structural contexts and preventing more robust understandings of medicalisation as a historically grounded social phenomenon. This piece contends that by decoupling medicalisation from neoliberalism and acknowledging deeper histories, contemporary scholarship can more effectively examine medicalisation as a distinct social phenomenon, while acknowledging the diverse logics of power (including neoliberal power) that can facilitate it.
Medicalisation beyond neoliberalism
Contemporary notions of medicalisation generally frame it as a product of evolving neoliberal medical regimes and the proliferation of new forms of medical knowledge and practice within them. These perspectives situate medicalisation within the particularities of neoliberalism, including the privatisation and optimisation of economic and state processes, and the expansion of market logics into new social and institutional domains (Esposito and Perez, 2014). Scholars analyse how these transformations facilitate the expansion of the pharmaceutical industry, the restructuring of health care practices around corporate and market-orientated frameworks, and the emergence of new markets for medical commodities and services (Zeira, 2021).
While these perspectives highlight critical developments in contemporary medicalisation, they often rely too heavily on consumer or market-driven framings, such as situating medicalisation within a broader expansion of ‘governmentality’ (Lemke 2011, p. 5): a theory describing how contemporary power structures produce entrepreneurial subjects who internalise power relations and enact self-regulation and self-optimisation. In this formulation, power does not directly repress or constrain individual agency, but instead conditions subjects to autonomously reproduce repressive structures (Fries,2008). Prevailing medicalisation perspectives draw extensively on the ‘governmentality’ framework, positioning the phenomenon within the rise of medical consumerism, wherein subjects exercise agency by internalising the role of patient as consumer.
In this respect, contemporary medicalisation scholarship attributes the phenomenon to the increasing consumerist and market-driven orientation of medical practice, reflecting the broader expansion of these under neoliberalism. This framing, however, often neglects historical processes not typically associated with neoliberalism and, at times, abstracts analyses of governemntality from the broader historical frameworks in which they are embedded. In other words, medicalisation perspectives draw on concepts such as marketisation or corporatisation as analytical tools with limited acknowledgement of the critical traditions from which they emerge. This narrows the epistemic breadth of contemporary medicalisation studies, neglecting deeper genealogies of medical regimes and the historical continuities and transformations they reveal.
Such limitations, I argue, can be addressed through greater attention to how neoliberal regimes transform and reproduce existing structural processes of medicalisation. Scholar Bruce M.Z. Cohen illustrates this by showing how contemporary mental health care mobilises enduring logics of regulating disordered conduct featured in traditional constructions of the asylum patient (Cohen 2016, pp.62-63). In other words, Cohen exemplifies how neoliberal mental health ideologies emerge from broader histories of pathologising social deviance,
The contemporary approach also constrains understandings of medicalisation as a distinct social phenomenon. Within medicalisation scholarship, heterogeneous logics of control and structures of power unique to the medical realm are often subsumed within a prevailing market-driven framework. This obscures the significance of medical practice itself as a site of (often highly disciplinary) power and diminishes attention to points of divergence between neoliberalisation and the trajectories of contemporary medical regimes. The significance of medical control are evident in scholarship on sex and sexuality. As Thea Cacchioni observes, a wide range of beliefs and anxieties extending across normative, social and physical domains, are mobilised in the medicalisation of human sexual activity, constructing discourses of value and taboo (Cacchioni 2015, pp. 449-450). Decoupling medicalisation from neoliberalism allows these diverse processes to be more fully recognised and critically examined, cultivating deeper understandings of their distinct relation to medicine as a mode of practice.
Diverse actors driving medicalisation
In her work on the diversity of medical discourses on sexuality, Cacchioni illustrates the numerous ways subjectivity is be formed by medicalisation processes. This contrasts with prevailing medicalisation frameworks, which center on a uniquely autonomous model of the neoliberal subject as the primary agent of medicalisation. In the latter model, medicalisation occurs through subjects actively internalizing medical norms and choosing to self-commodify by becoming medical consumers (Fries, 2008). Focusing exclusively on an autonomous construction of the neoliberal subject neglects the more coercive and marginalising dynamics underlying the medicalisaation process which disproportionately affect vulnerable populations. This is evident in repressive medicalisation processes which constrain rather than condition agency, imposing medical logics through the social authority of medical regimes, seen in practices of involuntary psychiatric intervention or forced biometric surveillance (Porter, 2015).
The expansion of the pharmaceutical industry under neoliberalism exemplifies how directly repressive logics operate through medicalisation to shape and regulate marginalised populations. While often interpreted as driven by a growing drive for medical consumerism (Sholl, 2017), increased pharmaceutical intervention also occurs through more coercive and violent means, such as when pharmaceutical practices are employed outside market frameworks to enhance capacities for structural control and surveillanace. Marginalised populations, such as asylum seekers and prisoners, are often forced to accept pharmaceutical interventions through structural coercion and duress, while simultaneously subjected to heightened surveillance and psychological monitoring under the guise of mental health care (Briskman, Zion, and Loff 2012). These practices impose medical frameworks rather than presenting them as consumer choices and embody a distinct drive to mobilise medical authority as a site of structural coercion rather than a justificatory logic of market expansion.
The repressive aspects of pharmaceutical medicalisation highlight the overtly repressive logics embedded within current medical practice, where individual agency is undermined rather than directed towards self-driven or consumerist-oriented medical expansion. Within contemporary medicalisation literature, these dynamics are often overlooked or cast as anachronisms endemic to historical medical regimes. This framing neglects how disciplinary logics of power actively evolve through neoliberal regimes, and even operate within self-driven processes of medicalisation (Briskman, Zion, and Loff 2012). To effectively address these dynamics, medicalisation scholarship must decenter the autonomous neoliberal subject and expand theoretical and empirical frameworks to account for the diverse modalities of power that operate.
Conclusion: Towards Broader Frameworks and Logics of Medicalisation
Overall, contemporary medicalisation scholarship remains insufficiently engaged with the deeper histories that shape processes of medicalisation, as well as the diverse logics of power that animate them. This work could be strengthened by drawing more extensively on scholarship examining the medicalisation of deviance and by moving beyond frameworks that reduce medicalisation to an extension of neoliberal governmentality. Broadening the scope of analysis enables more critical and comprehensive accounts of medical knowledge and practice, while also bringing into focus its most harmful and coercive dimensions. Such engagement is essential for challenging the role of medical practice as a mechanism of social control, and thus contributing to healthcare practices that are more sustainable, equitable, and genuinely supportive.
About the author
Liam Marshall is an undergraduate student at the University of Toronto, pursuing studies in Political Science and Sociology. His academic interests focus on political and cultural theory, with particular attention to the structures of power that shape social life. He is currently completing an undergraduate thesis examining biopolitical scholarship on the Palestinian occupation.
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