Medicalization and Machines: Is Bad Breath a Disease?

I’ve been doing some readings for my course in health communication and I have been thinking about the idea of medicalization – how it has changed how we think about our bodies, health, and its implications for health communicators and educators.

In The Body and Social Theory (1993), C. Shilling identified “the body as a machine” as a common metaphor we use to think about our bodies and health. From this perspective, our bodies are a collection of parts that, when functioning properly, work like a, er, “well-oiled machine.” If a part breaks, it can be fixed. For every malfunction, there is a scientific solution. Regardless of whether this metaphor is a good one, it certainly plays a role in what we call “medicalization.” In a medicalized society, the mechanics are doctors who use medicine to repair the body when it malfunctions. So when we talk about medicalization, we’re talking about the idea that every physical “malfunction” has a treatment or remedy. And that works oh-so-well with another hugely prevalent force in our society: consumerism.

If every ailment has a remedy, then someone is going to get rich off of selling remedies. A doctor once pointed out to me that the more options there are to treat an ailment, the less effective the treatment is likely to be. I guess that’s the difference between a “remedy” and a “cure.” When we’re talking about something curable, there’s usually only one cure. If it’s just “treatable” like the common cold, there are likely to be more options. And none of them really “cure” anything, they only treat the symptoms.

Viral illnesses like the common cold are great for people selling remedies; they are malfunctions of the body-as-machine that need fixing, but they aren’t really “curable” so we shell out money hoping for that “magic remedy” to fix the problem and get our bodies back in working order. Rather than put a hole in the body-as-machine metaphor, we accept the remedies as necessary, just as necessary as medical “cures.” The body-as-machine metaphor transcends the reality of the common cold as something that can’t be “fixed” and instead legitimizes our need or demand for products like Advil Cold and Sinus.

But what if you have a product for which there is no medical need? If you’re Listerine, you invent one. Ever heard of halitosis? It’s a term for “bad breath,” which is not, by the way, an actual “disease” or “illness” of any kind. Halitosis is a term invented by Listerine as part of an epically successful ad campaign.

Joseph Lister developed antiseptic at the end of the 19th Century. A similar but less potent form was developed by Jordan Wheat Lambert, who asked the famous Lister if he could use his name to market the product. Thus, Lambert’s Listerine was born. It was used for sterilization, cleaning floors, and even treating gonorrhea. In 1895 it began to be marketed towards the dental profession as they discovered it was good at curing oral germs. And then, Lambert hit on the best idea ever: medicalize bad breath and sell Listerine as the cure.

He and his copywriters all but invented the term “halitosis” and used it in an aggressive ad campaign designed to make everyone self-conscious about our smelly breath. Remember, at this period in history, there were different standards of oral hygiene. This ad campaign is in part responsible for the difference in standards today. The campaign asked, “Always a bridesmaid, never a bride?” or “Could I be happy with him in spite of that?” and stated plain and simple, “Halitosis makes you unpopular!”

(I know there were a few ads directed towards men, but I can’t find them online. It seems as though the majority of these ads were aimed at women.)

Do you remember a time before we had to carry mints or gum, talked about “coffee breath,” or just spoke freely without worrying about the smell of our words? Well, Listerine killed it. James B. Twitchell, author of Twenty Ads that Shook the World (2000), names this advertising strategy “generating constructive discontent,” and Listerine wasn’t the only company to use it successfully.

Body odor came from Lifebuoy soap; athlete’s foot came from Absorbine Jr.; “five o’clock shadow” from Gilette; tooth film from Pepsodent; and split ends from Alberto V05. Americans today spend almost $4 billion a year on products whose only purpose is to alter natural body odors, odors unsmelled a generation ago!

(I wonder what Twitchell would think of vaginal rejuvenation surgery and the Va-J-J Visor…)

The halitosis ad campaign was so successful that most of us know the word, and understand it to be the “medical term for bad breath.” We also consider athlete’s foot a medical condition, and can buy “prescription strength” deodorant that costs over $10 a stick. They say that “sex sells,” but I think health may sell more directly. And as these products are labeled as health remedies or medical treatments, they expand the medicalization of our society and reinforce the idea that our bodies can run like machines if we maintain them properly.

It makes me wonder about my own so-called “health condition”: eczema, or “dry skin.” While some have more extreme cases of eczema, or psoriasis, my eczema is mild. It’s just dry skin that gets worse in dry weather. In a worst case scenario, patches of dry skin become itchy and feel rough to the touch. Yet, I have seen a dermatologist and I have been diagnosed with mild eczema. I was even prescribed a steroid cream to use during “outbreaks,” and it was recommended that I use a “dermatologist approved” moisturizer like Eucerin or Cetaphil every day. A bottle of Eucerin costs nearly $15, compared to something like Jergens, which costs $4. But then again, I think Eucerin is in a different class than “regular” moisturizers, and does a better job with my eczema. Or do I just feel that way because I have developed brand loyalty, and enjoy feeling like I have a medical condition with a simple, successful, medical treatment?

So is my eczema a disease? Or is dry skin, like bad breath, just an occasional annoyance of being human? Would I feel differently about my skin if I had never been diagnosed by a dermatologist?  Would it change the fact that I find comfort in the routine of, literally, “oiling” my body-as-machine?

And if eczema, like halitosis, is just a made up word in order to medicalize a normal physical thing, is the deceit harmful or benign?