MEDICALISATION RECONSIDERED - TOWARD A COLLABORATIVE APPROACH TO CARE

The concept of 'medicalisation' has informed the sociology of health a nd illness for several decades. Typically, it has been discussed with critical connotations, although some commentators have suggested that it is not unequivocally negative. This paper seeks to clarify the conc ept, suggests that medicalisation can be both helpful and unhelpful, a nd identifies the characteristics of beneficial medicalisation. Using data from doctors and patients who are dealing with a refractory, rela psing and disabling condition - Chronic Fatigue Syndrome - we explore the impact of medicalisation in different forms on the participants in the medical encounter. Both doctors and patients were, at times, unea sy about the possibility of a self-fulfilling prophecy through which a medical diagnosis might generate deleterious consequences from a comp aratively trivial complaint. However, when such motivations prompted d octors to withhold information (such as a suspected diagnosis), the re sults were generally increased difficulties for the patient. Whether i ntentional or accidental, medical dominance in any form consistently g enerated problems for patients. But when medical explanations were mob ilised to enhance the coherence of the patient's experience of symptom s, patients found medicalisation to be helpful. Patients whose doctors took their symptoms seriously gained legitimation which helped them i n a range of social relationships. They also received support for thei r efforts at self-management, Legitimacy, coherence and support are al l necessary components for improved well-being, and doctors can supply such assistance even in the absence of unequivocal diagnosis and prov en therapeutic interventions.