Medicalisation of sleep and wakefulness

Question 1

Outline the elements involved in medicalisation

Answer 1

• Needs to be a biologically plausible explanation of the illness
• Needs to be something that articulates a current preoccupation
• Need to have an authority voice within medicine
• Need a method of diagnosis
• Need an acceptable treatment

Question 2

Provide examples of partially medicalised conditions

Answer 2

• shyness or social phobia: while social confidence is a current preoccupation, authority figures from psychiatry, a method of diagnosis via DSM-4/5, and acceptable treatment e.g. cognitive therapy or SSRIs however there is uncertainty as to its biological plausibility
• rage: is biologically plausible, is a current preoccupation, and treatment with SSRIs and mood stabilisers proposed; but no authority voice exists for this yet and there is uncertainty as to the method of diagnosis
• dark skin e.g. in India: while biologically plausible, a preoccupation, tratement with skin bleaching creams, and has a method of diagnosis, there are no medical authority voices
• ageing: is biologically plausible, current preoccupation, authority voices, method of diagnosis, but we do not have widely acceptable methods for arresting the appearance for ageing

Question 3

In sociological theory, medicalisation is often constructed as being disempowering for patients? When (and why) might patients regard medicalisation as empowering?

Answer 3

A good example of medicalisation as empowering process is the medicalisation of fatigue into chronic fatigue syndrome (or other fatiguing illesses). Patients who felt their legitimacy as ill people questioned, found that the diagnosis of CFS reinforced the legitimacy of their illness. Medicalisation can be empowering because it gives patients the licence to be sick/adopt the sick role – so it’s particularly useful when the symptoms are disabling and common.

Question 4

What’s the connection between SIDS and sleep apnoea?

Answer 4

SIDS helped redefine sleep as a period of danger – potentially life-threatening. Sleep had previously been regarded as a time of replenishment or revelation, but not a state in which one could mysteriously die. The recasting of sleep as dangerous was revisited a decade later when sleep apnoea became a widely-used diagnosis. The popular understanding of SIDS as arbitrary reconnected the ideas of sleep and danger for sufferers of sleep apnoea.

Question 5

Outline the arguments for and against the pharmaceutical enhancement of wakefulness

Answer 5

Arguments for the pharmaceutical enhancement of wakefulness:
- enhances cognitive capacity in the weary so useful for sleep-derived persons (military personnel and students)
- enables us to double our effective living time
- makes society more effective in a global economy (can keep industry working efficiently through the night, communicate across time zones)

Arguments against:
- we are uncertain of long-term consequences of chronic sleep ablation (many neurophysiological events occur during sleep e.g. secretion of growth hormone)
- potential risk of losing leisure time
- a social or economic compulsion ot take wakefulness enhancers for industry to be competitive

Question 6

Why is sleep viewed as a problem now?

Answer 6

• increase in diagnosis -> social change
• more attention socially
• similar levels globally
• generally distributed problem in the community
• OSA: rates increase with age
• Note also: short sleep, poor quality sleep incidence is high

Question 7

List different cultural sleep patterns

Answer 7

• monophasic: Western cultural notion
• biphasic sleep culture
• napping cultures

Question 8

Why might sleep apnoea be considered incompletely medicalised ?

Answer 8

Standard of care is CPAP.
Many patients are not compliant due to bulky machine.
Has improved in recent years.
Not cheap either.

Not fully acceptable or affordable.
Therefore sleep apnoea is at present an incompletely medicalised condition.