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An uncomfortable intimacy
Published in Alan Bleakley, Medical Education, Politics and Social Justice, 2020
Here, medicine operates as a dominant discourse or is hegemonic so that a wide range of behaviours and experiences previously unlabelled become marked as symptoms – medical or health issues. For example, everyday angst becomes treatable “anxiety”. Social behaviours are read as symptomatic ills of a social body that can be treated largely by pharmaceuticals. “Big Pharma” (Law 2006) colludes with, or even shapes, the medicalization project with a promise of profit. Szasz (2003) suggests that this leads to a “pharmacracy”, a culture dependent upon prescribed drugs, where Big Pharma, embracing the most profitable and largest of global companies (Ledley et al. 2020), exerts undue power. Medicine and politics are inextricably mixed, as pharmaceutical companies also become major lobbyists, particularly in American politics.
The Disabled Body
Published in Roger Cooter, John Pickstone, Medicine in the Twentieth Century, 2020
What is in doubt is not medicalization per se, but rather, its vulgar sociological rendering in terms of social control models that exclude, or can be juxtaposed to, other kinds of disability narratives. By casting medicalization in this way, and styling it a “traditional narrative,”23 disability advocates in the late twentieth century in effect did unto the medical profession what they would not have others do unto the disabled: treat as ‘other.’ But not only is this ‘othering’ and juxtaposing historically wrong (as we have seen), it is also misguided. Besides conflating pathologization with the empowering of doctors to control it, it overlooks the fact that in late-modern’ Western society, the culture of medicine extends to the whole of culture, not just to pathologized parts. Medical discourse now reaches into the corners of everyone’s social and psychological selves. ‘Being’ no longer hinges crucially on the ability to enter into productive labor; rather, it has become tantamount to ‘well-being’ which, if not always subject to professional medical management, is, consciously or unconsciously, subject to our own medicalized measurement and monitoring. In this sense we have all been medicalized. To speak of the medical profession as an external social controlling force on the disabled is therefore naive.
Ethics in the Era of Precision Medicine
Published in Lawrence S. Chan, William C. Tang, Engineering-Medicine, 2019
Medicalization describes a conceptual shift which perceives, diagnoses, and treats the individual—particularly their nonmedical problems—from a medical perspective, and identifies the subsequent dangers of overtreatment that result from such a perspective (Hadler 2004, Conrad 2007). Clifton Meador (1994) in a provocative commentary on medicalization describes a fictitious patient encounter set in the near future, where the protagonist is a middle-aged, former stockbroker who retires from his second profession to give full attention to the demands of preventive care and medical testing in his constant pursuit of health. To the patient’s chagrin nothing can be found to be wrong with him, but this is the last person for whom this was true. While Meador’s satirical reflection predates the rise of both personalized and precision medicine, the concern about the trend toward medicalization has continued. Nicol et al. (2016) describe similar concerns in actual patient care referring to the emerging phenomena of “patients in waiting”.
Problems of Living: Perspectives from Philosophy, Psychiatry, and Cognitive-Affective Science
Published in Psychiatry, 2022
Stein is so thoroughly reasonable in everything he says – there’s that word again! – that it’s difficult to disagree with him unequivocally. This reasonableness, this taking-the-middle-road, however, leads Stein to make statements on some occasions that may appear trite. For instance, “the aim of treatment is not to entirely rid the individual of negative experiences; not all pain and suffering should be medicalized, and we need to avoid both underdiagnosis and overdiagnosis in psychiatry” (p. 133). While it’s hard to disagree with that, I can’t help but feel that it glosses over just how difficult it is to determine the limits of medicalization in a manner that avoids both underdiagnosis and overdiagnosis. This is a topic that is close to my heart, and I have grappled with it for years and still do (Aftab & Rashed, 2021). Since there is no natural boundary out there that we can appeal to, there is no straight-forward correct answer. In words of Derek Bolton, “It is evident enough that these implications of giving up on naturalism in this context, on the idea that mental disorder is fundamentally a matter of fact, leads to a characteristic post- or late-modern – the word ‘mess’ comes to mind. In place of absolute fixed facts and boundaries we find flux, appearing different from different points of view, and requiring negotiation between them” (Bolton, 2008; p. xxviii). Again, I do not think that Stein would disagree with this, but readers of the book will not leave with any visceral appreciation of the “mess” we are in and the absence of a stable ground.
The medical model and its application in mental health
Published in International Review of Psychiatry, 2021
Over medicalization is an issue that concerns all of medicine (Sackett et al., 1991) not least because of the risk of iatrogenic harm for little chance of benefit (Treadwell & McCartney, 2016) and some critics of psychiatry have highlighted this as a particular issue in psychiatry due to lack of clear differentiators between health and purported mental disorder (Kinderman et al., 2013). If clear rules for defining medical disorders existed this would help focus medical care on appropriate problems avoiding over-medicalization, but naturalist models so far have not been able to successfully carve out notions of dysfunctions in a value-free manner. Normativist models also do not provide any clear boundary with regards to the domain of medicalization (Bortolotti, 2020). In the absence of such a philosophical boundary, ‘medicalization’ often ends up as a rhetorical or political manoeuvre rather than as a useful scientific concept (Pies, 2013).
Insights into paediatric tube feeding dependence: A Speech-language pathology perspective
Published in International Journal of Speech-Language Pathology, 2020
Emily Jones, Helen Southwood, Catherine Cook, Tom Nicholson
Medicalisation is a powerful “lens” through which health professionals and the general populace make sense of health, illness, and embodiment. Medicalisation can also mean that the perspectives of medical staff may take precedence over the views of other health professionals (Kanieski, 2010) and that all practitioners tend to prioritise the immediate, narrow, biomedical outcomes over broader quality of life goals. In this study, the medical perspective often focussed on the medical condition of the child rather than their developmental potential and persisted beyond the time when tube feeding was initiated. Survey results suggested that the underlying medical diagnosis of the child is a factor contributing to tube feeding dependence and this is supported in the literature (Lively et al., 2019; Taylor et al., 2019). However, the interview participants added further insight, commenting that medical prioritisation of weight gain, beginning in the NICU environment, appears to affect the potential for weaning from tube to oral feeding. This prioritisation of weight can consequently affect the child in terms of appetite-loss and insufficient oral motor skills needed for transition (Shaker, 2013).