Medicalisation
2020-01-27 — 2026-04-20
Wherein the designation of a condition as a disease is examined in its political and economic dimensions, and the legitimacy thereby afforded to treatment is set against the stigma attendant thereon.
Stub. On the mechanics and political economy of calling phenomena diseases, versus other classifications.
Contested questions: Are the following phenomena best regarded through the lens of disease, or not? ADHD? Depression? Cognitive enhancement by nootropics? Personality disorders Transgender identities Non-majority sexual orientation? General weirdness? Treating things, even parts of things, as medical conditions is stigmatising. But also it motivates society to treat those conditions, which can be good. But what if the condition was something you are totally OK with, thank you very much. What are the trade-offs? When is something best treated as a disease, and when as… something unremarkable? Or: as a moral failing?
Why does classifying something as a disease make it more legitimate to treat it, whereas a mere wish to thrive does not? What are the status effects of calling something an illness versus a preference? I’m curious about the interaction with modernity, making disease legible and thus implicating it in e.g. the health care system.
To declare my interests: I suspect there are some diseases that are something close to a natural kind — specific viruses, sickle cell anaemia, for example — but that many things we treat as diseases are fuzzy and hard to pin down in the best of cases (cancer, immune disorders), and that many things we treat as diseases are “just” trait clusters that we have declared pathological syndromes for various reasons. I think that many diseases are not “real” in the sense of being natural nosological kinds.
I also think it doesn’t matter much. It doesn’t mean that the suffering from some syndrome is not real, nor that we should shy from treating it. It doesn’t mean we shouldn’t give something a name if we need a name to file expense claims and fill out actuarial tables. If we want to call that treating a disease, this seems OK to me. If we want to call that “helping people thrive” I am OK with that also. Words are for us to do things with.
1 Incoming
Gleech on idiopathies
Sam Atis, in More notes on ADHD, connects ADHD medication to nootropics and asserts no meaningful differentiation.
Lionel Shriver compares transgender identity to anorexia. That sentence is both a description of the content and a content warning. I disagree with her broad conclusion, but she does some interesting work.
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[…]this is a newsletter where I write about disability and capitalism, covering the politics of mental health, the history of popular psychology, and the philosophies of living outside the norm.
Iatrogenesis: the medical establishment creating diseases so it can treat them. Illich (1975):
… at another level social iatrogenesis is the medicalisation of life in which medical professionals, pharmaceutical companies, and medical device companies have a vested interest in sponsoring sickness by creating unrealistic health demands that require more treatments or treating non-diseases that are part of the normal human experience, such as age-related declines. In this way, aspects of medical practice and medical industries can produce social harm in which society members ultimately become less healthy or excessively dependent on institutional care. He argued that medical education of physicians contributes to medicalisation of society because they are trained predominantly for diagnosing and treating illness, therefore they focus on disease rather than on health.