Despite physicians’ near monopoly over medicalization historically, various stakeholder groups shape an increasingly complex process today. This study examines a relatively new initiative, “health coaching,” within the context of the changing nature of medicalization. Utilizing 51 in-depth interviews with attention deficit hyperactivity disorder (ADHD) coaches, participant observation from seven ADHD symposia, and ADHD coach publications, I examine coaching’s emergence as a partial challenge to medicalization. Findings reveal a field comprised mainly of individuals personally affected by ADHD whose dissatisfaction with institutionalized framings and practices underpins a push for liminal medicalization. Members move between medical and nonmedical discourses to frame ADHD as a paradox of pathology and gift. Additionally, they leverage and commodify personal experience alongside institutional and alternative knowledge into an adjunct or substitute to medication and potential challenge to therapy—one aimed at “self-actualization” versus “treatment.” Such efforts highlight (de)medicalization’s dimensionality, simultaneous medicalization and demedicalization, and a lay-driven enterprise’s role in such processes.

中文翻译：

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“药丸不能教授技能”：多动症辅导、身份工作以及推动多动症的阈值医疗化

尽管历史上医生几乎垄断了医疗化，但今天各种利益相关者群体塑造了一个日益复杂的过程。这项研究在医疗化性质不断变化的背景下探讨了一项相对较新的举措“健康指导”。通过对注意力缺陷多动症 (ADHD) 教练的 51 次深度访谈、七次 ADHD 研讨会的参与者观察以及 ADHD 教练出版物，我将教练的出现视为对医疗化的部分挑战。调查结果表明，这个领域主要由受多动症影响的个人组成，他们对制度化框架和实践的不满推动了阈值医疗化。成员们在医学和非医学讨论之间摇摆不定，将多动症视为病理学和天赋的悖论。此外，他们利用个人经验以及机构和替代知识并将其商品化为药物的辅助或替代品以及对治疗的潜在挑战——旨在“自我实现”而不是“治疗”。这些努力突出了（去）医疗化的维度、同时进行的医疗化和去医疗化，以及外行驱动的企业在这一过程中的作用。