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Erschienen in: Medicine, Health Care and Philosophy 3/2015

01.08.2015 | Scientific Contribution

Medicalization and epistemic injustice

verfasst von: Alistair Wardrope

Erschienen in: Medicine, Health Care and Philosophy | Ausgabe 3/2015

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Abstract

Many critics of medicalization (the process by which phenomena become candidates for medical definition, explanation and treatment) express concern that the process privileges individualised, biologically grounded interpretations of medicalized phenomena, inhibiting understanding and communication of aspects of those phenomena that are less relevant to their biomedical modelling. I suggest that this line of critique views medicalization as a hermeneutical injustice—a form of epistemic injustice that prevents people having the hermeneutical resources available to interpret and communicate significant areas of their experience. Interpreting the critiques in this fashion shows they frequently fail because they: neglect the ways in which medicalization may not obscure, but rather illuminate, individuals’ experiences; and neglect the testimony of those experiencing first-hand medicalized problems, thus may be guilty of perpetrating testimonial injustice. However, I suggest that such arguments are valuable insofar as they highlight the unwarranted epistemic privilege frequently afforded to medical institutions and medicalized models of phenomena, and a consequent need for greater epistemic humility on the part of health workers and researchers.
Fußnoten
1
I am grateful to an anonymous reviewer for highlighting Davis’ definition of medicalization. Although I shall focus on ‘medicalization’ per se in this essay, several critiques focus on more specific aspects of biomedical constructions of phenomena, and refine their terminology appropriately. ‘Biomedicalization’, for instance, has been used to describe particularly technoscientific and individualistic forms of medicalization (Clarke et al. 2003), while ‘pharmaceuticalization’ (Abraham 2010; Bell and Figert 2012) and ‘geneticization’ (Lippman 1998) concern the particular forms of medicalization that concentrate on drug-based interventions for, or genetic explanations of, phenomena, respectively.
 
2
One reviewer raised the question of whether it is appropriate to consider this an injustice, rather than merely a harm; since I am following Fricker’s terminology, I am not necessarily concerned with adjudicating on this either way, but the close association Fricker draws between the social processes producing hermeneutical injustice (i.e. inequitable hermeneutical participation), and those responsible for different forms of social injustice, goes some way to motivate her choice; it also serves a heuristic advantage in highlighting these similarities.
 
3
It is important to note here that Fricker uses (and I shall follow her) the term ‘power’ in a way that (a) does not necessarily entail that its exertion is unjust, and (b) is always to some extent dependent upon structural concerns (a coordinating and enabling social context). It may operate “purely structurally”—not exerted by any given agent or agent(s), but rather as the cumulative result of the lives and actions of everyone living within a given community, acting as enabled and constrained by their social environment (Fricker 2007, 10–13). Fricker (2007, 159) suggests that hermeneutical injustice is always purely structural, though others suggest that at times it may arise as ‘wilful’ or ‘culpable’ ignorance, implying additionally some exertion of agential power (Pohlhaus 2011; Mason 2011).
 
4
As one reviewer highlighted, the idea of a ‘proportionate’ epistemic privilege perhaps requires some further development. As I shall use the term, it is proportionate to epistemic warrant, which I take roughly to concern both the empirical success of a discipline in accounting for certain phenomena, and the objectives against which the empirical success of a field’s work is measured. Thus, for instance, medical authorities have a proportionate epistemic privilege in the field of acute treatment of bacterial pneumonias, both because biomedical models of pneumonia and its treatment are highly successful in explaining the pathogenesis, pathophysiology, and mechanism of action of various therapies, and because the ‘pragmatic’ goal of curative treatment is one of the main measures of medicine’s empirical success.
 
5
Indeed, it is less the question of medicalization’s misdescription that worries Elliott, so much as the exclusivity of its description; he accepts that the medical standpoint may be valuable, but is concerned about the possibility of its becoming the only one available. As he puts it:
On Prozac, Sisyphus might well push the boulder back up the mountain with more enthusiasm and creativity. I do not want to deny the benefits of psychoactive medication. I just want to point out that to see him as a patient with a mental health problem is to ignore certain larger aspects of his predicament connected to boulders, mountains, and eternity (Elliott 2004, 160).
 
6
I am grateful to an anonymous reviewer for this last example.
 
7
This view of respect as involving viewing another as a potential reasoner and being willing to engage with them as a potential bearer and giver of knowledge can be found inter alia in the work of Christine Korsgaard (1996) and Stephen Darwall (2009).
 
8
It is worth noting here that, of the critics of medicalization discussed above, Carl Elliott notably does not ignore the kinds of testimony regarding depression discussed here; rather, it is precisely the nature of this testimony that worries him, in relation to its causal origins. One may question, however, the level of credibility Elliott attributes to the evaluative judgments in such testimony; much of his critique may be read as concerning the ‘adaptive’ nature of those preferences (Elliott 1998, 2004).
 
9
Kraemer provides an extensive reading of the testimony of such patients in terms of enhanced authenticity (Kraemer 2010).
 
10
The patients interviewed by Karp portray a range of reactions to medical management, from the unambiguously positive [“Instead of thinking I was becoming inauthentic by taking medication, I realised that I was totally inauthentic when I wasn’t taking medication because I was doing things that made me somebody that I didn’t want to be” (2007, p. 124)] to the deeply suspicious [“the pills take me away from me, they do something else. The lithium sort of organises me, the Wellbutrin lifts me up, the Benadryl puts me down. But it’s not me” (p. 113)]. The majority, however, display some degree of ambivalence: acceptance through desperation [“I have nothing else to put my faith in” (p. 89)]; viewing the medical lens as offering an accurate, but partial, picture [“[I]t’s kind of like there’s two me’s. There’s the depressed me and there’s the happy me. So the depressed me is me, but the nondepressed me is also me. So it’s not really changing me” (pp. 124–125)]; or embracing the benefits of medicalization but regretting the consequent dependence [“I think I’ll always regret having started medication even for any of the good that it did in my life. To not know what I could do on my own without it is very difficult” (p. 89)].
 
Literatur
Zurück zum Zitat Abraham, John. 2010. Pharmaceuticalization of society in context: Theoretical, empirical, and health dimensions. Sociology 14(4): 603–622.CrossRef Abraham, John. 2010. Pharmaceuticalization of society in context: Theoretical, empirical, and health dimensions. Sociology 14(4): 603–622.CrossRef
Zurück zum Zitat Barnes, Elizabeth. 2009. Disability and adaptive preference. Philosophical Perspectives 23(1): 1–22.CrossRef Barnes, Elizabeth. 2009. Disability and adaptive preference. Philosophical Perspectives 23(1): 1–22.CrossRef
Zurück zum Zitat Bechtel, William, and Robert C. Richardson. 2010. Discovering complexity: Decomposition and localization as strategies in scientific research. Cambridge: The MIT Press. Bechtel, William, and Robert C. Richardson. 2010. Discovering complexity: Decomposition and localization as strategies in scientific research. Cambridge: The MIT Press.
Zurück zum Zitat Bell, Susan, and Ann Figert. 2012. Medicalization and pharmaceuticalization at the intersections: Looking backward, sideways, and forward. Social Science and Medicine 75(5): 775–783.CrossRef Bell, Susan, and Ann Figert. 2012. Medicalization and pharmaceuticalization at the intersections: Looking backward, sideways, and forward. Social Science and Medicine 75(5): 775–783.CrossRef
Zurück zum Zitat Bonner, Adrian, and Ian Gilmore. 2012. The UK responsibility deal and its implications for effective alcohol policy in the UK and internationally. Addiction 107(12): 2063–2065.CrossRef Bonner, Adrian, and Ian Gilmore. 2012. The UK responsibility deal and its implications for effective alcohol policy in the UK and internationally. Addiction 107(12): 2063–2065.CrossRef
Zurück zum Zitat Brownmiller, Susan. 1999. In our time: Memoir of a revolution. New York: The Dial Press. Brownmiller, Susan. 1999. In our time: Memoir of a revolution. New York: The Dial Press.
Zurück zum Zitat Calhoun, Cheshire. 1988. Justice, Care, Gender Bias. The Journal of Philosophy 85(9): 451–463. Calhoun, Cheshire. 1988. Justice, Care, Gender Bias. The Journal of Philosophy 85(9): 451–463.
Zurück zum Zitat Campaner, Raffaella. 2011. Understanding mechanisms in the health sciences. Theoretical Medicine and Bioethics 32(1): 5–17.CrossRef Campaner, Raffaella. 2011. Understanding mechanisms in the health sciences. Theoretical Medicine and Bioethics 32(1): 5–17.CrossRef
Zurück zum Zitat Carel, Havi, and Ian James Kidd. 2014. Epistemic injustice in healthcare: A philosophical analysis. Medicine, Health Care and Philosophy 17(4): 529–540. Carel, Havi, and Ian James Kidd. 2014. Epistemic injustice in healthcare: A philosophical analysis. Medicine, Health Care and Philosophy 17(4): 529–540.
Zurück zum Zitat Clark, Jocalyn. 2014. Medicalization of global health 1: Has the global health agenda become too medicalized?’ Global Health Action 7: 23998. Clark, Jocalyn. 2014. Medicalization of global health 1: Has the global health agenda become too medicalized?’ Global Health Action 7: 23998.
Zurück zum Zitat Clarke, Adele, Janet Shim, Laura Mamo, Jennifer Ruth Fosket, and Jennifer Fishman. 2003. Biomedicalization: Technoscientific transformations of health, illness, and U.S. biomedicine. American Sociological Review 68(2): 161–194.CrossRef Clarke, Adele, Janet Shim, Laura Mamo, Jennifer Ruth Fosket, and Jennifer Fishman. 2003. Biomedicalization: Technoscientific transformations of health, illness, and U.S. biomedicine. American Sociological Review 68(2): 161–194.CrossRef
Zurück zum Zitat Conrad, Peter. 1992. Medicalization and social control. Annual Review of Sociology 18: 209–232. Conrad, Peter. 1992. Medicalization and social control. Annual Review of Sociology 18: 209–232.
Zurück zum Zitat Cosgrove, Lisa. 2011. The DSM, big pharma, and clinical practice guidelines: Protecting patient autonomy and informed consent. International Journal of Feminist Approaches to Bioethics 4(1): 11–25.CrossRef Cosgrove, Lisa. 2011. The DSM, big pharma, and clinical practice guidelines: Protecting patient autonomy and informed consent. International Journal of Feminist Approaches to Bioethics 4(1): 11–25.CrossRef
Zurück zum Zitat Darwall, Stephen. 2009. The second-person standpoint: morality, respect, and accountability. Cambridge: Harvard University Press. Darwall, Stephen. 2009. The second-person standpoint: morality, respect, and accountability. Cambridge: Harvard University Press.
Zurück zum Zitat Davis, Joseph E. 2010. Medicalization, social control, and the release of suffering. In The new blackwell companion to medical sociology, ed. William Cockerham, 211–241. Singapore: Wiley-Blackwell. Davis, Joseph E. 2010. Medicalization, social control, and the release of suffering. In The new blackwell companion to medical sociology, ed. William Cockerham, 211–241. Singapore: Wiley-Blackwell.
Zurück zum Zitat Elliott, Carl. 1998. The tyranny of happiness: Ethics and cosmetic psychopharmacology. In Enhancing human traits: Ethical and social implications, ed. Erik Parens, 177–188. Washington: Georgetown University Press. Elliott, Carl. 1998. The tyranny of happiness: Ethics and cosmetic psychopharmacology. In Enhancing human traits: Ethical and social implications, ed. Erik Parens, 177–188. Washington: Georgetown University Press.
Zurück zum Zitat Elliott, Carl. 2004. Better than well: American medicine meets the American dream. New York: W. W. Norton & Co. Elliott, Carl. 2004. Better than well: American medicine meets the American dream. New York: W. W. Norton & Co.
Zurück zum Zitat Fitzpatrick, Mike. 2004. From “nanny State” to “therapeutic State”. The British Journal of General Practice 54(505): 645. Fitzpatrick, Mike. 2004. From “nanny State” to “therapeutic State”. The British Journal of General Practice 54(505): 645.
Zurück zum Zitat Fricker, Miranda. 2007. Epistemic injustice: Power and the ethics of knowing. Oxford: Oxford University Press.CrossRef Fricker, Miranda. 2007. Epistemic injustice: Power and the ethics of knowing. Oxford: Oxford University Press.CrossRef
Zurück zum Zitat Garry, Ann. 2001. Medicine and medicalization: A response to purdy. Bioethics 15(3): 262–269.CrossRef Garry, Ann. 2001. Medicine and medicalization: A response to purdy. Bioethics 15(3): 262–269.CrossRef
Zurück zum Zitat Giere, Ronald N. 2009. An agent-based conception of models and scientific representation. Synthese 172(2): 269–281.CrossRef Giere, Ronald N. 2009. An agent-based conception of models and scientific representation. Synthese 172(2): 269–281.CrossRef
Zurück zum Zitat Glennan, S. 2005. Modeling mechanisms. Studies in History and Philosophy of Science Part C: Studies in History and Philosophy of Biological and Biomedical Sciences 36(2): 443–464.CrossRef Glennan, S. 2005. Modeling mechanisms. Studies in History and Philosophy of Science Part C: Studies in History and Philosophy of Biological and Biomedical Sciences 36(2): 443–464.CrossRef
Zurück zum Zitat Heath, I. 2013. Overdiagnosis: When good intentions meet vested interests—an essay by iona heath. BMJ 347: f6361.CrossRef Heath, I. 2013. Overdiagnosis: When good intentions meet vested interests—an essay by iona heath. BMJ 347: f6361.CrossRef
Zurück zum Zitat Illich, Ivan. 1977. Limits to medicine: Medical nemesis—the expropriation of health. New York: Penguin Books Ltd. Illich, Ivan. 1977. Limits to medicine: Medical nemesis—the expropriation of health. New York: Penguin Books Ltd.
Zurück zum Zitat Illich, Ivan. 2003. Medical nemesis. Journal of Epidemiology and Community Health 57(12): 919–922.CrossRef Illich, Ivan. 2003. Medical nemesis. Journal of Epidemiology and Community Health 57(12): 919–922.CrossRef
Zurück zum Zitat Karp, David A. 2007. Is it me or my meds? Living with antidepressants. Cambridge: Harvard University Press. Karp, David A. 2007. Is it me or my meds? Living with antidepressants. Cambridge: Harvard University Press.
Zurück zum Zitat Korsgaard, Christine M. 1996. The sources of normativity. Cambridge: Cambridge University Press.CrossRef Korsgaard, Christine M. 1996. The sources of normativity. Cambridge: Cambridge University Press.CrossRef
Zurück zum Zitat Kraemer, Felicitas. 2010. Authenticity anyone? The enhancement of emotions via neuro-psychopharmacology. Neuroethics 4(1): 51–64.CrossRef Kraemer, Felicitas. 2010. Authenticity anyone? The enhancement of emotions via neuro-psychopharmacology. Neuroethics 4(1): 51–64.CrossRef
Zurück zum Zitat Kramer, Peter D. 1997. Listening to prozac. New York: Penguin Books. Kramer, Peter D. 1997. Listening to prozac. New York: Penguin Books.
Zurück zum Zitat Kukla, Rebecca. 2005. Conscientious autonomy: Displacing decisions in health care. Hastings Center Report 35(2): 34–44.CrossRef Kukla, Rebecca. 2005. Conscientious autonomy: Displacing decisions in health care. Hastings Center Report 35(2): 34–44.CrossRef
Zurück zum Zitat Lippman, Abby. 1998. The politics of health: Geneticization versus health promotion. In The politics of women’s health: Exploring agency and autonomy, ed. Susan Sherwin, 64–82. Philadelphia: Temple University Press. Lippman, Abby. 1998. The politics of health: Geneticization versus health promotion. In The politics of women’s health: Exploring agency and autonomy, ed. Susan Sherwin, 64–82. Philadelphia: Temple University Press.
Zurück zum Zitat Machamer, Peter K., Lindley Darden, and Carl F. Craver. 2000. Thinking about mechanisms. Philosophy of Science 67(1): 1–25.CrossRef Machamer, Peter K., Lindley Darden, and Carl F. Craver. 2000. Thinking about mechanisms. Philosophy of Science 67(1): 1–25.CrossRef
Zurück zum Zitat Marmot, M. G., J. Allen, P. Goldblatt, T. Boyce, D. McNeish, M. Grady, I. Geddes, and others undefined. 2010. Fair society, healthy lives: Strategic review of health inequalities in England post-2010. Marmot, M. G., J. Allen, P. Goldblatt, T. Boyce, D. McNeish, M. Grady, I. Geddes, and others undefined. 2010. Fair society, healthy lives: Strategic review of health inequalities in England post-2010.
Zurück zum Zitat Mason, Rebecca. 2011. Two kinds of unknowing. Hypatia 26(2): 294–307.CrossRef Mason, Rebecca. 2011. Two kinds of unknowing. Hypatia 26(2): 294–307.CrossRef
Zurück zum Zitat McCoy, D., H. Montgomery, S. Arulkumaran, and F. Godlee. 2014. Climate change and human survival. BMJ 348: g2351.CrossRef McCoy, D., H. Montgomery, S. Arulkumaran, and F. Godlee. 2014. Climate change and human survival. BMJ 348: g2351.CrossRef
Zurück zum Zitat Morgan, Kathryn Pauly. 1998. Contested bodies, contested knowledges: Women, health, and the politics of medicalization. In The politics of women’s health: Exploring agency and autonomy, ed. Susan Sherwin, 83–121. Philadephia: Temple University Press. Morgan, Kathryn Pauly. 1998. Contested bodies, contested knowledges: Women, health, and the politics of medicalization. In The politics of women’s health: Exploring agency and autonomy, ed. Susan Sherwin, 83–121. Philadephia: Temple University Press.
Zurück zum Zitat Moynihan, R., J. Doust, and D. Henry. 2012. Preventing overdiagnosis: How to stop harming the healthy. BMJ 344: e3502.CrossRef Moynihan, R., J. Doust, and D. Henry. 2012. Preventing overdiagnosis: How to stop harming the healthy. BMJ 344: e3502.CrossRef
Zurück zum Zitat Narayan, Uma. 2002. Minds of their own: Choices, autonomy, cultural practices, and other women. In A mind of one’s own: Feminist essays on reason and objectivity, 2nd ed, ed. Louise Antony, and Charlotte Witt, 418–432. Oxford: Westview Press. Narayan, Uma. 2002. Minds of their own: Choices, autonomy, cultural practices, and other women. In A mind of one’s own: Feminist essays on reason and objectivity, 2nd ed, ed. Louise Antony, and Charlotte Witt, 418–432. Oxford: Westview Press.
Zurück zum Zitat Nervi, Mauro. 2010. Mechanisms, malfunctions and explanation in medicine. Biology and Philosophy 25(2): 215–228.CrossRef Nervi, Mauro. 2010. Mechanisms, malfunctions and explanation in medicine. Biology and Philosophy 25(2): 215–228.CrossRef
Zurück zum Zitat Parker, W.S. 2010. Scientific models and adequacy-for-purpose. The Modern Schoolman 87(3): 285.CrossRef Parker, W.S. 2010. Scientific models and adequacy-for-purpose. The Modern Schoolman 87(3): 285.CrossRef
Zurück zum Zitat Patton, Cindy. 2007. Bullets, balance, or both: medicalization in HIV treatment. The Lancet 369(9562): 706–707.CrossRef Patton, Cindy. 2007. Bullets, balance, or both: medicalization in HIV treatment. The Lancet 369(9562): 706–707.CrossRef
Zurück zum Zitat Pohlhaus, G. 2011. Relational knowing and epistemic injustice: Toward a theory of willful hermeneutical ignorance. Hypatia 27(4): 715–735.CrossRef Pohlhaus, G. 2011. Relational knowing and epistemic injustice: Toward a theory of willful hermeneutical ignorance. Hypatia 27(4): 715–735.CrossRef
Zurück zum Zitat Rose, Steven. 2013. Commentary on Singh: Not robots—children’s perspectives on authenticity, moral agency and stimulant drug treatments. Journal of Medical Ethics 39(6): 371.CrossRef Rose, Steven. 2013. Commentary on Singh: Not robots—children’s perspectives on authenticity, moral agency and stimulant drug treatments. Journal of Medical Ethics 39(6): 371.CrossRef
Zurück zum Zitat Singh, Ilina. 2013a. Victimology versus character: New perspectives on the use of stimulant drugs in children. Journal of Medical Ethics 39(6): 372–373.CrossRef Singh, Ilina. 2013a. Victimology versus character: New perspectives on the use of stimulant drugs in children. Journal of Medical Ethics 39(6): 372–373.CrossRef
Zurück zum Zitat Singh, Ilina. 2013b. Not robots: Children’s perspectives on authenticity, moral agency and stimulant drug treatments. Journal of Medical Ethics 39(6): 359–366.CrossRef Singh, Ilina. 2013b. Not robots: Children’s perspectives on authenticity, moral agency and stimulant drug treatments. Journal of Medical Ethics 39(6): 359–366.CrossRef
Zurück zum Zitat Verweij, Marcel. 1999. Medicalization as a moral problem for preventive medicine. Bioethics 13(2): 89–113.CrossRef Verweij, Marcel. 1999. Medicalization as a moral problem for preventive medicine. Bioethics 13(2): 89–113.CrossRef
Metadaten
Titel
Medicalization and epistemic injustice
verfasst von
Alistair Wardrope
Publikationsdatum
01.08.2015
Verlag
Springer Netherlands
Erschienen in
Medicine, Health Care and Philosophy / Ausgabe 3/2015
Print ISSN: 1386-7423
Elektronische ISSN: 1572-8633
DOI
https://doi.org/10.1007/s11019-014-9608-3

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