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5.3.3. Epistemic, pragmatic and moral justification of pain and harm
It can also be argued that some traits and experiences labelled as ‘problems’ in the
process of medicalization serve an important epistemic, pragmatic or moral
function and are therefore justified. For example, sadness may point to aspects of
one’s life that need improvement, and provide a motivation for change. Moreover,
even if the undesirable situation cannot be ameliorated, there may be value in
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knowing what predicament one is in (an epistemic gain) and sadness and grief can
be seen as ‘appropriate’ (morally and/or epistemically) reactions to a loss.
For example, Lehrer (2010) mentions a psychiatrist who was distressed to notice
that in his effort to ameliorate depression he failed to distinguish patients whose
problem has a mainly social component from those whose problem stems from
physiological reasons. The psychiatrist changed his mind when a patient, asked
about the effectiveness of medication answered: ‘Yes, they’re working great . . . I
feel so much better. But I’m still married to the same alcoholic son of a bitch. It’s
just now he’s tolerable’ (p. 42).
Lehrer points out that because the woman’s problem was rooted in her relationship
with her alcoholic husband rather than in her dysfunctional body, it was a mistake
to treat her. Parens agrees that construing her normal human unhappiness as
depression would be, as he calls it, a distressingly bad form of medicalization. If we
put aside the practical and conceptual problem of how effective for wellbeing and
happiness such intervention is (we can reach different answers referring to different
theories of happiness), the separate issue that arises here is that of the epistemic
worth of the experience and authenticity. As Parens put it,
‘[n]o matter how much the medication might attenuate her
suffering, that could not justify her becoming complicit in
cutting herself off from an important feature of her life as it truly
was.’ (2011, p. 4).
I think that this is an important consideration in evaluating the choice of the ways
and means we use to better our lives. This is not, however a problem that is
restricted to medical solutions. Marx has famously called religion, ‘opium of the
people,’ arguing:
‘Religious suffering is, at one and the same time, the expression
of real suffering and a protest against real suffering. Religion is
the sigh of the oppressed creature, the heart of a heartless world,
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and the soul of soulless conditions. It is the opium of the
people.’ (Marx, 1843)
Karl Marx was not alone in seeing the function of religion as problematic. Similar
views were shared by thinkers as diverse as the early romantic poet philosopher
Novalis (1997), poet and essayist Heinrich Heine (1840), and priest and professor
Charles Kingsley (Selsam, 1963). I do not attempt here to outline the various
functions that religion can play (see: Durkheim, 1915; Alpert, 1938) nor to reflect
on the moral, political, social and epistemic issues that arise when discussing
religion, but rather suggest that various ways of construing the meaning of human
experience, of looking at and remedying human problems, may lead to the same
practical or epistemic detachment from the reality of the lived experience. A doubt
similar to that which Parens’ raised about the use of medicine and Marx about
religion can be also raised about the increasingly popular (for its stress-reducing
effects) practice of meditation, and all kinds of other practices that would make us
feel better by avoiding facing the problems that most affect our well-being. These
include the tendency to get involved in work to escape family troubles, writing
poetry to alleviate, rather than examine, one's existential pains and sorrows and
humour – where it makes the unbearable bearable. Perhaps then, Keats would
inspire Conrad’s
attack when he states in
Sleep and Poetry
that ‘the great end / Of
poesy’ is ‘that it should be a friend / To sooth the cares, and lift the thoughts of
man’ (Keats, 1816, p. 68).
I am not arguing that the questions about alienation (vague as this term may be)
from our situation should not be raised. In fact (although somewhat beside the
point), I am sympathetic to many of the worries that the psychiatrists in Lurie
(2010) raise when they point out the possible detrimental effects of the use of
pharmacological mood enhancement. However, the main issue is not that the
solution is medical, nor that it happens within the ‘medical gaze’ as critics of
medicalization such as Conrad would have us think. Rather, legitimate doubts can
be raised about various ways of modulating our emotions and memories and
making ourselves feel better in general. If we are too much like the subjects
willingly plugging ourselves into the available equivalents of Nozick’s (1974)
experience machine, the locus of the problem is not in the
pharmacopeia
we might
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have available to achieve that goal, or whether or not that
pharmacopeia
is only
available on prescription.
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