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Essay: Sleeplessness has become medicalized in Western civilization

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  • Published: 15 November 2019*
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Introduction

Eight hours: the supposed holy grail of sleep. The act of sleep is widely accepted as a biological necessity, however beyond a certain extent, the value of sleep is amplified and imparted on Western society through health discourses. Through these discourses, sleep, and thereby sleeplessness, has become medicalized; this is the sociological process by which nonmedical concerns become characterized and treated as medical concerns, usually in terms of illnesses or disorders (Conrad, 1992). In 2002, about one-third of Canadian’s aged 15 or older reported experiencing symptoms of insomnia at least some of the time, and through medicalization, this statistic has presumably increased (Statcan.gc.ca, 2017). Historically, occasional sleeplessness was simply a part of the universal human experience; however, now defined as a treatable disorder, the prescription of sedatives is the strongest indicator that sleeplessness is becoming increasingly medicalized in society (Hislop & Arber, 2003). In this paper I argue that through the processes of shifting discourses, growing media attention, and excessive diagnosis, sleeplessness has become medicalized in Western civilization. Further, the greater implications of the progressive medicalization of sleeplessness will be investigated.

For the purpose of this analysis, sleeplessness, insomnia and sleep deprivation, all equally refer to the chronic or occasional inability to experience uninterrupted sleep.

Shifting Discourses

Discourse is a construction of understanding through structures and systems in society. Further, dominant discourse is influenced by relations of power and governs what is universally understood. Overtime, depending on those in positions of power and their evolving beliefs and agendas, discourse shifts in an attempt to produce a particular outcome. A historic example to convey the transformation of a dominant discourse over time was the shift from the universal belief that the earth is flat, to thinking it is round, to finally arriving at the current understanding that the earth is actually oblate. Although this may appear to be a simplistic example, discourse is active in all things through institutions, policies, media, cultures, and relationships.

Specifically, concerning health, dominant discourses govern what practices are deemed healthy or unhealthy by those in positions of power and imparted and understood in Western culture through social structures. Further, health discourse clearly defines how health is understood and what specific factors interact to determine it. Comparably to how the universal understanding of the shape of the earth changed through discourse, the understanding of health changes over time through the same mechanism.

A Brief History of Sleeplessness

Throughout history, the discourse of sleep and sleeplessness has occupied several interpretations and connotations. In Insomnia: A Cultural History, Eluned Summers-Bremner reveals insomnia, which she identifies as the “embodiment of a double negative, the absence of unconsciousness,” has afflicted societies for centuries in several forms (2010, p. 70). For instance, in medieval Europe, interrupted sleep was a symptom of bed bugs and the fear of arson, burglary, political conspiracy, and most jarring: the devil and his minions (Summers-Bremner, 2010, p. 38). The latter drove devotees to make their beds extremely uncomfortable to further impede their sleep to protect themselves. Moreover, Summers-Bremner suggests that in the fourteenth century, municipal clocks and bells produced a “heightened awareness of insomnia,” (2010, p. 53).  Later, insomnia was perceived as as an indication of an unsettled mind due to the rising popularity of Shakespeare’s work. These few examples illustrate the evolving understanding of insomnia in society over time and how it will presumably continue to change in the future.

The New Generation of Sleeplessness

Although recommended, in today’s 24/7 world, routinely achieving eight hours of uninterrupted sleep is becoming increasingly difficult to achieve. The new culture of sleeplessness revolves around increasingly accessible technology and information. In the era of possessing all information at the touch of a button, people find themselves over stimulated and unable to disengage at the end of the day, leading to sleeplessness. Further, the meaning of insomnia has changed in the sense that we tend to regard sleep as a privilege rather than a human entitlement; therefore, sleeplessness is normalized in our society as the way of life for many. Despite sleeplessness becoming normalized and almost expected, health discourse persists and continues to reaffirm the behaviour as a medical condition. The current discourse surrounding sleeplessness has approached a medical model rather than a social model; insomnia is perceived as a condition to be cured rather than investigating what social structures have elicited this behaviour in such a large proportion of the Western population. This further fuels the progressive medicalization of sleeplessness and highlights the urgency of finding a treatment. The modern connotation and understanding of sleeplessness – controlled by discourse – lends itself to the increasing medicalization of the behaviour because our society structurally supports and actively endorses this mentality.

Growing Media Attention

The media has played an integral role in the progressive medicalization of sleeplessness. As previously mentioned, the media is one of the several structures active in society that reproduce and instill particular discourses. The media has the power to exaggerate the prevalence of a disease, encourage over-diagnosis, and overemphasize the benefits of a given treatment (Williams, 2008). Concerning sleeplessness, the British media positioned coverage to focus on how insomnia seemingly derives from psychological disruption. The focus on a psychologized discourse is communicated through personalized narratives, sometimes written by those directly affected by insomnia (Williams, 2008). In 2005, The Guardian published a reflection from a self-confessed chronic insomniac; an excerpt of this submission follows:

“I write this as I am stranded in the limbo land between days. It is three o’clock in the morning and everything that is hidden in the background of my daily life has come crawling forth…”

This subjective work instills the active psychological discourse reaffirming the medicalization of sleeplessness as a psychological disorder, and perhaps even a symptom of potential underlying pathologies (Williams, 2008).

Interestingly, the use of women in case studies regarding sleeplessness is a conscious act to feminize the disorder in the media, as “women are perceived as more likely than men to have problematic experiences defined and treated medically” (Hislop, 2003). With this, it is expected that women would be used as primary research candidates to authenticate and popularize the medicalization of sleeplessness in the media.

Therefore, collectively the media is a purposeful tool used to progress medicalization in society. In this particular instance, the media helped to medicalize sleeplessness using psychological discourse and feminization.

Excessive Diagnosis

Sleeplessness has been a part of the human experience for our entire existence; however, in less than three decades, the diagnosis and treatment of insomnia has exponentially increased. Moloney and colleagues arrive at this conclusion in a study where population-based surveys were randomly distributed to physicians across the United States yearly between 1993 and 2007 (Moloney, 2011). Consistent with the medicalization hypothesis, sleeplessness complaints and insomnia diagnoses have increased over time, but are far outpaced by issued prescriptions for sedative hypnotics (Moloney, 2011). Results suggest that approximately 2.7 million office visits involved complaints of sleeplessness in 1993; however, by 2007, this figure had more than doubled to 5.7 million. Interestingly, during this period, insomnia diagnoses increased more than 7-fold, from 840,000 to 6.1 million (Moloney, 2011). And finally, prescriptions for nonbenzodiazepine sedative hypnotics (NBSH) increased about 30-fold during the observation period to amount to 16.2 million prescriptions in 2007 (Moloney, 2011). This figure suggests that alternative concerns were potentially being treated with medical solutions, as the number of insomnia diagnoses pale in comparison to the number of issued prescriptions. Therefore, the excessive diagnosis and prescription of sedative hypnotics is a strong indicator of the ongoing medicalization of insomnia.

Commodification

Western society’s desire to sell and commodify just about anything lends itself to the medicalization of insomnia and further fuels the pandemic of excessive diagnosis. Commodification is the transformation of any good into an object of trade; in this case, sleeplessness has been converted into a profitable concept. Apart from the aforementioned increasing market for sedative hypnotics, hundreds of products have been produced and marketed to guarantee an uninterrupted sleep. Sleep has seemingly become formulaic, with an established right or wrong way to achieve the best night’s sleep and the market has targeted this notion to sell anything and everything. From mattresses, to pillows, bed linen, eye masks, noise machines, and far beyond, purchasing the supposed perfect sleep is accessible anywhere and anytime, but at a price. The capital gain of a buyable remedy is substantial and contributes to the potential motivation to continue the process of shifting health discourse to further medicalize and treat sleeplessness.

Greater Implications

The progressive medicalization of sleeplessness poses greater implications beyond shifting discourses. As a consequence of the continuing medicalization of sleeplessness, the diagnosis and treatment of insomnia is increasing in the younger demographic (Moloney, 2011). The sedative hypnotics often prescribed to treat insomnia are highly addictive and when unnecessarily prescribed, especially to the younger population, the risk of misuse increases. The 2014 National Survey on Drug Use and Health reported that 2.1 million Americans used prescription drugs nonmedically for the first time within the past year; 30 percent of those initiates were adolescents (Drugabuse.gov, 2017). Presumably, as the medicalization of insomnia increases, the misuse of prescription hypnotic sedatives will linearly increase and eventually be characterized as a public health crisis, comparable to the current state of opioids. Further, as a society, participating in and passively reaffirming dominant health discourses maintains the few positions of power in place that govern several aspects of society. Collective reflexivity is urgently necessary to accept that as a society we idly reproduce and engage in these dominant discourses, which actively affects each life. Therefore, the aforementioned implications of the medicalization of sleeplessness supersede sleeplessness itself and reveal systematic, and potentially problematic, mechanisms at work in society.

Conclusion

In conclusion, through the processes of shifting discourses, growing media attention, and excessive diagnosis, sleeplessness has become medicalized in Western civilization. As a physiological process, sleep will always be necessary, however, the associated health discourses will presumably continue to change over time, as it has throughout history. Further, the current era of mass media and technology will continue to contribute to the medicalization of sleeplessness by increasing accessibility to information framed and presented in a particular way to produce a specific understanding. Moreover, excessive diagnosis and treatment is a pandemic in Western society that reaches beyond insomnia, which poses several threatening implications. Medicalization is a neutral process; however concerning insomnia, the extent to which this particular case of medicalization will continue to afflict society reveals potentially harmful outcomes. Further investigation should focus on identifying the social structures active in society that elicit these trademark symptoms of insomnia in a large proportion of the population, opposed to the present methodology of employing a medical model to classify and treat sleeplessness as a medical disorder.

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