Beds or Meds? the Changing Societal Responses to Mental Health Problems in Affluent Democracies, 1960-2003

Societies increasingly rely on medical solutions to solve a wide array of problems. Classic theories of medicalization give almost exclusive power to the medical profession as defining and responding to health problems, while newer theories have begun to acknowledge alternative players. Yet, current theories and research are embedded within the U.S. context. This paper moves research on medicalization into a comparative perspective by looking at the medicalization of mental health in 19 advanced, industrialized nations from 1960-2003. It uses three macro-theories to understand processes of medicalization, specifically globalization, the welfare state, and theories of profession. Using data from the OECD and the Yearbooks of International Non-Governmental Organization, I test hypothesis of macro-level effects on medicalization of mental health, captured by two indicators (institutionalization and reliance on psychiatric medication), that undoubtedly put mental health problems under the medical jurisdiction. The findings clearly show that all three macro-level factors have the potential to both support and counter medicalization. Regarding globalization, membership in public INGOs decreases medicalization whereas membership in psychiatric INGOs increases medicalization. The welfare state both supports and counters medicalization. The welfare state as a whole facilities deinstitutionalization, but public spending on health increases both reliance on institutions and medication. Finally, professionals follow global trends regarding deinstitutionalization but protect their professional power by guarding their exclusive right to prescribe medication. The findings clearly show important links between medicalization, globalization, the welfare state, and professions.