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MLA APPLICATION Fall 2016 CYNTHIA MIAO
Table of Contents STUDIO WORKS
01
Plastered Landscape
02
Waikiki 2050
03
Thomas Square
04
Merging the Masters
05
Weaving Into Site
4th Year Architecture Design Studio Arch 415, Fall 2014
3rd Year Architecture Design Studio Arch 342, Spring 2014
3rd Year Architecture Design Studio Arch 341, Fall 2013
2nd Year Architecture Design Studio Arch 201, Spring 2013 2nd Year Architecture Design Studio Arch 201, Spring 2013
DESIGN COMPETITION
06
Kawailoa Design/Build
Kawailoa Wind Farms/Kupu Hawaii, Spring 2014
CREATIVE WORKS
07
Hand Renderings, Ceramics, and Photography
WRITING SAMPLE
08
Medicalization of Society
This project requirement were to explore and understand the materiality of plaster which would then be applied to building and design strategies. While creating these plaster subjects I found myself following the curves and walking along the plastered landscape. I felt challenged to recreate this feeling through form.
01
PLASTERED LANDSCAPE Arch 415 - Byoungsoo Cho - Fall 2014 - 4 weeks
Site Plan
Seochon is one of Seoul’s oldest districts and holds countless historical landmarks and heritage. Due to its cultural significance and peaceful nature, many artists and writers flock the streets which are lined with galleries and studios. Similarly, in the past Joseon leaders and poets lived in the area. In order to enlighten and replenish themselves, they would often retreat to the bamboo forest where they were embraced by nature.
SITE
USERS
CONCEPT Tradition
Business Employees
Writers/ Artists
Local Families
Tired from working in an office and wish to temporarily rest from their busy schedule.
Hoping for a catalyst that nurtures creative inspiration and intellectual growth.
Looking for a safe haven to connect with loved ones and enjoy a peaceful meal.
Modern Needs
Form
Because Seochon is progressively becoming more like the rest of Seoul—louder and busier, the proposed program is to create a modern bamboo forest where business workers, artists, writers, and even families can take a break from their busy lives to replenish themselves. My concept is to connect the tradition of seeking renewal with modern needs and the fluidity of plaster.
MATERIALITY AND FORM EXPLORATION
Plaster subject was created by slightly manipulating a thick pvc plastic into a box mold and using mesh as reinforcement. Gravity allows the plaster to sink into the crevices and harden into smooth, sweeping form--showing the materiality of plaster and pv plastic.
mesh reinforcement
pvc plastic
Digital Model box mold
A
Section A
Section B Fabrication B
Inform
The language of the surrounding context and existing circulation influences the energy of the new.
The building is sliced twice and are slightly offset from each other creating an entree way for light as well as appreciating the movements of the structure.
Openings into the building have been strategically located to correspond with the existing alleyways and pedestrian pathway network.
Floor Plan
Building Section
EXPERIENCE Upon entering the site, the user has an option to enter through the concrete entrances created by section cuts of my building or take the curved stairs up to the roof garden. The wider space is flat and allows for various activities such as picnicking, sketching, and reading. From here, the users can take a curved ramp downwards into the building where they are calmed by a pool of water where they can reflect silently. Inside is a quieter space with sunken seating for business meetings or study. Windows neighboring this seating area are easily slid open and closed to allow natural light and fresh air into the space. Although inside the building, users will not feel suffocated, but instead enlightened due to its openair quality. Moving further inside is a slanted wall with holes that allow light to enter, casting an interesting shadow on the floor as the day progresses. Beyond that is a smaller, more intimate space highlighted by a maple tree that changes with the season for those that wish to further retreat from the city. The ground floor outside the building was inspired by the flat areas of my plaster model and is left as an open green space.
02
WAIKIKI 2050
Arch 342 - M. Despang, D. Rockwood, M. Turin - Spring 2014 - 7 weeks
SEA LEVEL RISE As sea level continues to rise, it is becoming an important issue that needs to be tackled in urban and building design. When designing, sea level rise and other urban aspects are taken into consideration while developing our Waikiki 2050 scenario and building program.
THE SCENARIO The Waikiki of 2050 is reminiscent of the Waikiki in 2014. It continues to be a vibrant district attracting tourists from all over the world. With Hawaii’s green endeavors, O’ahu is no longer dependent on fossil fuel energy. However with the 3-feet sea level rise, electricity and commuting has become more difficult and expensive. With eliminated land space and rising tourism, the need to live denser is becoming more crucial.
Rail, Electricity, Goods Delivery, Waste Disposal Wastewater Treatment Water Taxi Transportation
CONCEPT
USERS
A mixed-use building with a live/work program that will provide various amenities from retail, restaurants, grocery, public green spaces, offices, and housing. Locals can work in various services and offices downstairs and live upstairs in residential units. Tourists will also live and play within the building and have access to community areas where they can interact with locals.
Tourist
Local Family
Hoping to immerse into the “Local Hawaiian� experience.
Moved into Waikiki to start a new life and experience a different style of living.
3
2 Food Retail Offices & Services Residential 1
Agriculture
STRUCTURE
With the sea level rise, the construction process has become more complicated and costly. Therefore existing buildings have been retrofitted and re-adapted to the needs of 2050.
Tension Cables Connected to the structural core and supports the concrete belts around the twin towers. Creates a unique and defined space that allows the users to feel protected and shaded while being able to see the infinity beyond it.
Concrete Belt Casted to the existing floor plate and are supported by the structural core and the tension cable. By having an elevated concrete belt, users will feel as if they are walking in the sky.
Floor Slabs Existing concrete floor plates have been kept while the interior partition walls have been recycled to adjust to new programs. Lobby ceiling have been raised to accomodate new water taxi traffic. Two levels of commercial spaces have also been added.
Core and Columns Existing columns and core to remain while additional columns have been added to support two new commercial floors.
Concrete Slab with Stilts Existing slab have been cut for water taxi pick-up and drop-off. Stilts have been introduced.
CONCEPT
Thomas Square is a significant part of Hawaiian history that remains on the island today. The purpose is to reactivate the park through built interventions, programs, and landscape design. My challenge was to reprogram this park to facilitate greater community interaction and education. New programs introduced are a community vegetable garden with a herb wall and a biofiltration ponds for storm-water treatment. In the center is a banyan tree pavilion that draws attention and provokes interaction. The focal and the historical symbol of the site are the banyan trees. My concept is to create a bridge between the past and the present by creating a modern structure that will age in time with the trees. As time goes on, the banyan tree’s aerial roots will wrap around the pavilion, making it grow denser and denser.
03
THOMAS SQUARE Arch 341 - W. Meguro - Fall 2013 - 8 weeks
Site Analysis
Vehicular traffic
Pedestrian traffic
Access paths
Vegetation Most of the existing trees were preserved, including the banyan trees at the center. A herb wall and garden were introduced. Built Structures Introduced programmatic elements include the banyan pavilion, amphitheater, food truck restaurant, and seating.
3
Paved Pathways Circulatory paths were designed as a reaction to the existing routes pedestrians and bikers took through the park. Water Features The water channel leads the users eye into the park and disappears within the banyan trees. Biofiltration ponds with native plants were introduced into the landscape to reduce pollution and runoff, and to serve as an educational tool for residents
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8
2
4 6
7 5
1 2 3 4 5 6 7 8
Floor Plan
0
25
50
100
Banyan Pavilion Amphitheater Water Channel Herb Wall Herb Garden Seating Biofiltration Ponds Food Truck Canopy
200 Feet
BANYAN PAVILION
BIOFILTRATION PONDS
Integration Over Time Existing sewage drains Ponds with native kalo
Year 1
Year 5
Native Kalo Gray Water Soil Stones
Year 15
Gravity Fed Pipe
Existing sewer lines were identified and re-piped to biofiltration ponds. Planted within ponds are native Hawaiian kalo used to educate students and public about history and the roles plants play in bioremediating water.
HERB WALL Herb wall designed to catch and channel rain water down pipes that would water the plants. Excess water would be stored for later use. Edible wall and garden are designed with the intention to surprise visitors and to make a new, meaningful connection to common food sources.
To Irrigation
Storage Tank
04
MERGING THE MASTERS Arch 201 - L. Longhi, L. Palagi, H. Zhou - Spring 2013 - 4 weeks
LEARNING FROM THE MASTERS
Richard Neutra
MODEL EVOLUTION
This project calls for us to work closely with three world renown architects of our choice. We are able to learn each architect’s thoughts, design process, techniques, and the personality it is inspired from. Their techniques are combined to create dynamic forms and spaces that houses many qualities of life.
Rogelio Salmona
Eero Saarinen
INTEGRATION Richard Neutra Neutra is well known for his minimal assemblies of lines and planes that reaches into space. His intervention was inspired by the R.J. Neutra School and how it sprawls into the landscape. Rogelio Salmona Salmona has a unique geometric and radial design language that stretches, breaks, and grows. His intervention inspired the circulation of the plan and the layering of shapes and detail.
Eero Saarinen Saarinen has the ability to design sweeping forms that suggest movement. He inspired the overall composition and motion of the design.
My Own This intervention weaves the three designers together in a manner that harmonizes the three design philosophies.
05
WEAVING INTO SITE Arch 201 - L. Longhi, L. Palagi, H. Zhou - Spring 2013 - 4 weeks
This project challenges to create a structure that harmonizes with its existing surroundings. The chosen site exists the Kresge Auditorium and the MIT Chapel, both designed by Eero Saarinen.
Concept
The two main users of the existing structures are the director of the performing arts and the priest-- both with differing ideas. The director of the performing arts is a master of the physical while the priest is drawn to the spiritual. As body and soul, the intervention is designed as a meeting place for the two connect.
The Director’s Path
The Meeting Place
Starting dark and enclosed but will open up the further down as he walks towards the chapel.
The center is the deck where the two will meet.
The Priest’s Path This journey will be filled with light as he head towards the avuditorium.
06
KAWAILOA DESIGN/BUILD COMPETITION 1st Place Team - Spring 2014 - 1 week - Clients: Kamehameha Schools, Kupu Hawaii
CONCEPT
For the challenge of designing a rain shelter, we thought it necessary first to consider the meaning of shelter. Shelter is commonly understood to be a place giving protection from danger, but in the Hawaiian language, the word for shelter, Wahi Lulu, can also be interpreted as Place of Calmness. With our design, we sought to create a place that not only acts to protects its users from the weather, but also to embrace the beauty of it. The roof structure is designed to shed rainwater onto the vegetated rock wall to remind the users that although we may need protection from the rain, we cannot forget that it is the source of life. Responsibilities: Design and rendering.
0
2
4
8
16
BUILDING COMPONENTS
The construction process of the design incorporates simple wood framing techniques and standard slab-on-grade foundation. The vegetated rock wall follows typical gabian wall construction. Corrugated steel panels will be bolted onto the wood trusses as well as suspended by steel rods. The overall process is simple and could be managed by any contracting group.
Gabion Wall
Corrugated Steel
Bamboo Reeds Wood Structure
Tension Rods
Seating
Concrete Slab
RAIN DIAGRAM
Our pavilion makes use of expansive overhangs to shield from both sun and rain. The open plan allows for air to flow freely through the space, maintaining a comfortable environment. Seating is placed to orient the users towards the windmills and the natural open space for convenience of presentation viewing.
CERAMICS & Hand Renderings
07
OTHER WORKS
HAND RENDERINGS
PHOTOGRAPHY San Francisco, California
Yoyogi Park, Tokyo, Japan
Gacheon Daerangi Village, South Korea
Doumen District, Guangdong, China
Hangzhou, Zhejiang, China
MEDICALIZATION OF SOCIETY Medicalization is a process that has morphed and changed society under it’s whim. According to Peter Conrad, it is described as a process where nonmedical problems become defined and treated as a medical problem. These problems are defined in medical terms and language, perceived through medical framework, and treated with medical intervention. Therefore behaviors that have once been defined as deviance such as alchoholism, ADHD, sexual and gender differences turn from badness to sickness (4-6). There are several advocates for medicalization such as social movements, patient organizations and individual patients. Recently, the pharmaceutical industry as well as potential patients have stepped into the playing field and dramatically influenced medicalization. As the public gains more awareness about diseases through social movements, organizations and other means, they grow less tolerant of mild symptoms, thus reclassifying it as diseases and reorganized into medical categories. However, there are certain constraints on medicalization such as differing definitions of illness, medicare costs, limited insurance coverage, etc. These factors are believed to effect the degrees in medicalization. The first degree involves the elasticity of medical categories. In other words, categories are able to grow or shrink according to the ever changing definitions of disorders. The second and last degree is that medicalization is bidirectional, meaning that demedicalization is also possible. As opposed to medicalization, demedicalization involves a problem that is no longer identified as medical and medical treatments are no longer used. Such examples are homosexuality, masturbation, and disability (6-8). Medicalization is viewed as a double-edge sword that can be helpful and yet unhelpful to patients. The process provides medical explanations to symptoms, validation, and support for patients’ troubles. However, Dorothy Broom and Roslyn Woodward sees a problem with this doctor-patient collaboration known as medical dominance. Here, legitimation is made through collaboration and not professional dominance. This means that physicians diagnosed according to what the patient wants as opposed to professional means. Adele Clarke and her colleagues reconceptualized medicalization as biomedicalization—changes in social forms and medicine that impacts medicalization (11-14). Through the process of medicalization, society’s perception of certain symptoms and problems change. The details that were not considered a medical problem becomes and gets treated as one. This shift will impact the individual’s experience and quality of life as medical treatments start being implemented into their daily routine. Although some interventions may be productive, others may not be necessary, or leave us worse off. For an example, I have had insomnia since the sophomore year of high school. My pediatrician suggested natural remedies such as warm milk before bed, a warm bath, or even listening to soothing music as opposed to sleep medication. I have previously taken sleeping pills that left me even more tired in the morning as opposed to having no sleep at all. It impaired
08
WRITING SAMPLE
my ability to function in the morning and left me worse off. In addition, sleeping pills also have addictive side effects in which the user becomes dependent on it to fall asleep. Therefore I opted out of using any sleeping medication but instead adopted nonmedical solutions. As medicalization grows, the medical market for diseases and its treatments also grows. With the Food and Drug Administration Modernization Act of 1997, restrictions were loosened. Pharmaceutical companies can now share with physicians “off-label” usages for their products. The amount of info required in DTC ads decreased, but companies can only advertise for the specific disease and age group it was tested for. However, physicians can prescribe it for any illness to any patient they find appropriate. As DTC ads increase, pharmaceutical companies become more involved in medicalization in order to create a market for their product. This is primary done by medicalizing more aspects in life. An example of such action is seen through the shifting usages of Paxil. Once approved for depression, the manufacturer requested other usages for the drug from the FDA because the depression market was already saturated. They decided to refocus on the the anxiety market, targetting social anxiety disorder (SAD), generalized anxiety disorder (GAD) and then emotions such as shyness and worry. GlaxoSmithKline spent millions of dollars in campaigns to raise awareness of SAD and GAD. Soon, FDA approved usage of Paxil for SAD. This is a fine example of pharmaceutical companies marketing diseases and not just drugs. The product director of Paxil, Barry Brand states, “Every marketer’s dream is to find an unidentified or unknown market and develop it. That’s what we were able to do with social anxiety disorder”. As a result, the physician’s role in medicalization becomes less significant in presence of pharmaceutical promoters (16-18). Treatments and cultural views can evolve through medicalization. A primary example involves the treatment of aging in men. In society, aging has been looked as a stigma with negative social beliefs and fears. Since people fear getting older, the process is medicalized in an attempt to control it, thus embracing medicalization. As more treatments spawn, men begin to understand and experience their bodies in terms of how it is socioculturally constructed and if the aging process is pathological (25-26). The medical perspective of aging is largely contributed to the discovery of testosterone. In past observations, men without functioning testicles lack masculine traits. Similarly, castrated animals become docile, plump and less active. In 1889, Charles Eduoard Brown Sequard injected himself with a solution comprised of testicular blood, testicular extracts, and seminal fluids from dogs and guinea pigs. He claims that it dramatically increased muscular strength, boosted the urinary jet stream by 25%, and on top of that, his chronic constipation disappeared. Enthused by Brown Sequard’s claim, physicians in France and U.S. attempted to adopt the same formula, but denounced it when similar results could not be reproduced. Although the extract did not work, he was the first to make a biological
connection with male aging and to suggest a medical treatment for it. Since then, pharmaceutical companies have continued to pursue more convenient and attractive treatments such as pills. With high availability of treatments, more men are likely to participate as consumers. A popular drug called AndroGel was approved by the FDA in February 2000 for conditions related to hypogonadism. It started by targeting a small population in hope to expand it through off-label uses. Their methods involved taking the “low T” quiz and advertisements. These advertisements portrayed testosterone as a fuel that can be used up and recharged—a typical situation (27-33). With aging is another symptom known as balding. In the past, ineffective remedies containing alchemy, magic, and superstition were used in the hope of reversing the symptom. However, modern medicine has taken a different approach and instead, researched the causes of balding. Their endeavers showed a male hormone called dihydrotestosterone that is found in balding men. This hormone causes hair follicles to produce fine, unpigmented hair and runs in families through a gene called “sonic hedgehog”. Modern treatments for balding are Rogaine, Procepia and hair transplant surgery. Rogaine was founded through the discovery of minoxidil, a ingredient found in Loniten. This drug was given as a treatment for high blood pressure, but a physician observed that it gave one of his patients new hair on his head. Since then, Loniten has been used as an “off-label” treatment for balding patients. Meanwhile Propecia works differently in the sense that it aids in prevention rather than regrowing hair. The last treatment is surgical treatment where “plugs” or “grafts” are implanted into the scalp to create a seemingly natural hairline. Although these treatments may not be as effective as desired or perhaps uncomfortable, men are willing to take the risk to control their aging (34-41). The last and most commonly known drug to combat male aging is Viagra. This medication is held with high demand because sexual function surrounds masculinity. In other words, a man’s ability to perform is in tie with their masculinity, considering their fertility does not expire. Viagra was first promoted for older men, but have increased to include all men. This is because every man is concerned with their aging and performance, therefore they are willing to try medical means to control it. Through this mindset, markets for such treatments are increasing (41-45). The expansion of the anti-aging market have grown to include virtually all men is known as a process called diagnostic expansion or domain expansion. This is a process where definitions of social problems grow to involve a greater population. An example of such as ADHD, once known as a disorder for children has grown to include adults. Through the Diagnostic and Statistical Manual of Mental Disorders (DSM) one can understand how behavior towards ADHD and other disorders developed and how the method of diagnosis changed. In 1968, the DSM-II used overactivity, restlessness and distractibility as common
symptoms of “minimal brain damage” and “hyperkinetic reaction”, both viewed as childhood disorders that should be outgrown in later years. However, studies in the late 1970s showed that previously diagnosed children still portrayed symptoms of hyperactivity, this coining them to be “adult hyperactives”. This was later reclassified in the DSM-III into two major subtypes: ADD with hyperactivity and ADD without hyperactivity. In order to be diagnosed with such disorder, patient’s symptoms must exhibit symptoms before hitting 7 years old. This action is an example of the expansion of diagnostic criteria by including more behaviors, thus including an additional population that would not have been relevant otherwise. In the DSM-III-R, ADD was renamed as ADHD and placed less emphasis on school-aged behaviors. This allowed the diagnosis to grow definitionally and changed “adult hyperactives” into “ADHD adults” who lacked childhood diagnosis (47-52). As more people are being diagnosed with ADHD, organizations such as CHADD sprouted that promoted understanding, acceptance, and treatment of ADHD. A pharmaceutical markets began to form and promote their ADHD medications through DTC ads. Children and adults alike started taking medication for ADHD. By doing so, ADHD turned into a lifetime disorder, making it possible to keep consumers on medication. However, medications proved to have a cardiovascular risk if continued. Another concern is once a patient is diagnosed or self-diagnosed, they start viewing past events, failures, and characteristics through medical lens. Blame is placed on a chemical imbalance rather than taking personal responsibility for life problems, making the diagnosis into a medical excuse. ADHD is viewed as an handicap or a disability linked with underperformance. Patients feel that they should be performing better, but cannot because they have a disorder such as ADHD. Therefore, they attempt to seek medical help to improve performance. Lastly, ADHD is believed to be passed through genetics and is distinguished by the overproduction of dopamine that reduces self-control. Although the genetics of ADHD is not yet certain, medical and public acceptance has grown to the point where adult ADHD is a social reality. This is how medicalized categories such as ADHD can grow definitionally to include more issues. However, the next question is where is the line between disease-treatments and medical intervention/enhancements? This topic is debated in the development of the Human Growth Hormone (hGH). This hormone is found in pituitary gland in children during their puberty state. It was then extracted and given to children with low hGH in hope of stimulating their growth. Unfortunately the extract was later taken out of market when four children died of Creutzfeldt Jakob disease after taking the medication. Later, a synthetic hGH medication called Protropin appeared on the market, promising a safer and abundant alternative. The company also published a diagnostic criteria for measuring GH levels, but produced varying results. In order to expand their market, the creators of Protropin started to implement other medical uses for hGH such as treating children with idiopathic short
stature, burned children, AIDs patients, etc. Some physicians and patients even believe that hGH contains anti-aging properties. The FDA later investigated Genetech and found that the unapproved uses of Protropin gained them about $20 million in profit. Other investigations show that doctors are being paid off by the company to prescribe hGH to patients regardless if they had tested hormone deficiency or not. An example of this is hGH being implemented on patients with idiopathic short stature. The argument against this action is that people come in different proportions and sizes. Statistics have shown that over time, heights increase possibly owing to better nutrition and living conditions. As people grow taller, perspective of height changes and a social stigma appears, especially applicable to men. Short men are viewed as being less attractive and less competent than tall men. While hGH may help an individual gain a few inches of height, there is no clear impact on the social and psychological consequences of being short (77-81). Meanwhile, hGH have also been used in anti-aging such as increasing lean body mass, muscle mass, decreasing fat, and restoring vitality in skin. Four years later, the results of the Rudman study showed no signs of improvement, instead, harmful side effects. These include joint pain, still hands, and swelling in ankles and other parts of the lower body. Despite the unpleasant side effects, the news of anti-aging have been published in media and more companies have spread claims regarding hGH and other enhancements. This brought upon the usage of drugs to enhance abilities such as athletic performance to create an uneven playing field. This includes drugs such as steroids that have bodily risk, but athletes continue to use it and see it as a “necessary evil for success” (81-86). HGH is an example of normalization where biomedical enhancements is used to bring the body to what is deemed “normal” or socially acceptable. This sort of medical enhancement is supposed to improve performance and make it better than it originally was. The desire for improvement is in line with the American culture where individuals strive to be better. Nonetheless, there is a social temptation to take advantage of interventions and enhancements. Later, these interventions will become a necessity and those that do not take these enhancements will be at a disadvantage. This also decreases social diversity because everyone will strive for an “ideal” and start becoming the same. Lastly, someone that takes enhancements will become a stigma by their peers because they tried to be someone they are not. Since there is no reversing enhancements such as hGH, the stigma will be difficult to bury (87-96). The evolution of ADHD and hGH medication are models of increasing medical categories. This happens when one medicalized category gains legitimacy it can grow to include other relevant human problems. Medicalization of problems can also be seen in the diagnosis of menopause. This state is believed to have been medicalized because it contains symptoms that were similar to a disease while others claim it is because of the availability in treatment. Hormone replacement therapy (HRT) was used to treat menopause. Later,
Estrogen Replacement Therapy (ERT) was used because estrogen is believed to prevent problems that come with aging such as breast and genital cancer. Research was then published depicting the detrimental risks of HRT which helped seal ERT’s place in the market. The rate of women using HRT plummeted but it was continued to be used to treat severe menopause in a short timeframe. While HRT helped medicalize menopause, it also did not demedicalize it after the plummet. This is because when a safer alternate is obtained, medical intervention is used once more (121-124, 132). A similar situation to the treatment of menopause is breast implant, an example of medicalized enhancement. Although only a few physicians saw small breasts as a disease, surgeons and women saw a medical solution to the issue. Silicone injects were first used, but proved to be a serious problem. With the persistence of women, silicone implants were introduced by Dow Corning in 1962. However, this alternate was also flagged down by the public and critics because of its potential consequences. Finally, the public settled on a safer alternate known as saline breast implants, thus causing breast implants to rise by 92%. This case is parallel to that of HRT where when a risk appears, the amount of users decrease. However, once a safer alternative is discovered, the amount of users increase once more. In terms of medicalization, only the usage of medical interventions was affected while neither conception or demand changed (124-126). With the recognition and isolation of personal issues, the amount of medical intervention increases. There are a huge variety of behaviors identified as disorders with over half the population having these traits. As more behaviors turn into a mental disorder, everyone will be labeled with having some sort of illness. This causes one to wonder where the line is between a disorder and a normal life problem? Nonetheless, the medicalization of problems have become widespread with an endless potential for uncovering more issues (132). The success in medicalization is partially thanks to the pharmaceutical and biotechnology industries. Pharmaceutical promote their products through DTC advertising and encourage “off-label” uses. In 2004, they spent about $4 billion on DTC advertising and with every $1 invested, they gain $4.20 in sales. Through these advertisements, pharmaceutical companies market diseases and then promote drugs to treat these diseases. However, several problems have occurred with such marketing. Private market of medical enhancements for children can be exploited by biotechnology companies. These companies’ goal is to increase the market size in order to bring about profit. In addition, the promotion and increase usage of enhancements will inevitably help medicalization of human problems to grow. Soon, identifying disorders through behaviors will shift to doing so through genes such as in the Human Genome Project where specific genes are mapped out. By finding out problems in genes, a new medicalized status is created known as the potentially ill, such as pre-cancer and pre-alcoholism. In turn, this will alter an individual’s identity, social status,
and even impact their insurability. Through the Human Genome Project, medical surveillance and medical gaze will continue to expand (134-138). Consumers also begin to play a significant role in medicalization when health care and care institutions can be selected. Now, health care and hospitals have to compete for patients whether it is through DTC advertisements or other methods. With the spread of information about new diseases, patients have begun to practice self-medicalization where patients visit physicians under self-diagnosis. After identifying their issue, patients turn into consumers and start demanding services and medical treatment for the problem. Lastly, managed care have also attributed to altering the playing field in medicalization. Managed care organizations often constrain the care given and care received by requesting pre-approval for treatments and placing a limit on certain types of care. These constraints encouraged doctors and medical organizations to value profits over care. In addition, medicare only covers certain types of procedures they determine appropriate, which skews patients’ decision in treatments (140-141). As previously observed, medicalization is now driven by commercial and market interests rather than professional means. With this mindset, companies look for more potential treatments to create new medical characters in order to stimulate business. When a new treatment enters the market, pharmaceutical companies can promote a new or underused medical definition in order to legitimize the product. In turn, this will change the definition of the disorder and even expand the definition enough to lower the threshold of an already medicalized problem. This situation is seen in the medicalization of erectile dysfunction, ADHD, and even pseudobulbar effect (PBA), which is uncontrollable laughing/ crying during unconventional situations. The creator of Avanir (treatment for PBA), Dr. Gerald J. Yakatan states, “Before there were drugs, these conditions didn’t exist”. This shows the impact drug companies have in social control. Matters come to worse when their best interest is to take care of their stakeholders rather than patients. Since stakeholders profit from the success of the pharmaceutical industry, they wish to promote more medications for human problems regardless if it improves health or medicare or not. Although this problem is largely an issue in America, the trend is beginning to spread to other countries through globalization. Pharmaceutical companies have reached Japan and promoted mild depression as a disease. As a result, SSRI treatment have dramatically increased since 1999 (142-145). The development of medicine have no doubt helped mankind, but overmedicalization is a problem. The expansion of medicalization transforms human differences into disorders. Examples are: Learning differences become learning disabilities or ADHD; uncommon sexual desires/performance turn into sexual dysfunctions; Shopping/internet addictions; social phobia; and so much more. Thus, tolerance and appreciation for human diversity decreases causing everyone to eventually be marked as sick. Medicalization does this by determining what is “normal” and what is the standard in life by setting information and promoting diagnoses. This action is seen as Viagra creates the expectation of sexual
performance and that men are expected to be sexually active until old age. Such expectations is called the expansion of Medical Jurisdiction, or medical social control. The scope of medical surveillance have increased to monitor individuals for potential illnesses. In turn, this will increase diagnosis and the production and usage of treatments. This approach focuses on individuals rather than the root of the problem in society. An example of such is diagnosing individuals with alcoholism rather than targeting the environment that promotes alcohol abuse (148-153). Another great example is the shift in methods of confronting disability. The medical view looks at patients through their impairments rather than the disabling properties in society. Through the disability movement, society has been changed to incorporate curb cuts in sidewalks, ramps, braille in elevators, sound indicators on crosswalks, etc. The disability movement is known to be a successful battle against medicalization (152-153). Medicalization have proved to act as a double-edged sword that can either help or hurt society. While the process can aid individuals in identifying their problem and gaining support for it, it may not be necessary. In attempt to isolate human behaviors and refocus it medically may not be the best approach in solving problems, if any at all. When looking through medical lens, one forgets about the social factors that may have attributed to the behavior. In addition, the medicine that was once sought to help people have become a large profit engine for pharmaceutical and biomedical companies. With this, the interest is no longer in helping people, but instead transformed to generating money. Ultimately, medicalization have exhausted its good motives of benefiting society and re-concentrated on diagnosing society until each individual is labeled sick. Works Cited: Conrad, Peter. 2007. The Medicalization of Society. Baltimore, MD:The John Hopkins University Press.
CYNTHIA MIAO Phone: (808)-232-3904 Email: cynmiao@gmail.com