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5.3.1. The ‘category mistake’ argument examined
In a somewhat purified form, the category-mistake critique of medicalization states
that it is epistemically incorrect to see life problems as medical ones. This argument
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relies on an assumption that there are problems that are appropriately seen as
medical or not. Yet, as with many issues, there are several perspectives that one
could take on them. For example, the observation that people of lower
socioeconomic status tend to have worse health can be construed as a moral,
political, health or economic problem. Similarly, explaining the causes and
conceptualizing criminal behaviour may include referring to moral failure of
individuals, condition known as psychopathy or asocial personality disorder,
economic and social factors (‘the mad’, ‘the bad’, and ‘the disadvantaged’
explanations).
All those ways of looking at it put the stress on one aspect of the problem, and this
may lead to different kinds of solutions. We might evaluate the usefulness of one or
another focus, but we would be hard pressed to point to some objective ‘essence’ of
a problem that makes it
inherently
political, moral or economic. Similarly, sadness,
shyness and criminal behaviour may be approached from different perspectives.
While some perspectives may be more useful or feel more comfortable than others,
given that it is unlikely that there is something inherent in the way the world is
structured that would force us to adopt one and not another perspective, an
essentialist position is hardly justified. Thus, this critique needs an additional
assumption to hold any ground.
Another weaker version of this critique of medicalization points to the concern that
that the medical way of framing issues, while not a category mistake in the way that
saying ‘I am my body’ is, tends to push out other approaches. The critic may accept
that we need both ways of looking at ourselves to get what we want or need, but
worry when this interpretation is taking over. This claim is more plausible, but it
has to be 1) justified empirically to show that the mentioned ‘replacing’ of
perspectives actually happens and 2) shown that an alternative construction of a
problem is valuable in some way and should not be lost. This is rarely demonstrated
or argued for, and thus significantly weakens the ethical appeal of the
medicalization arguments.
Perhaps the issues surrounding medicalization are best seen to relate to power and
economy. Firstly, we might justifiably raise a question about who is in the best
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position to make a difference and get us what we want. For example, even if
sadness or shyness are normal and usual responses to our wider life circumstances,
and being spotty or impotent are not ‘medical problems in their essence’, where
doctors are in a position to provide some solutions, we might accept medicalization
and the treatment of those conditions as ‘illnesses’ rather than wait for the access to
those drugs to be deregulated and demedicalized.
In this context, it is worth asking whether access to certain goods and tools needs to
be mediated by the medical profession, or whether it would be better to leave it up
to the individual to decide. For example, we might think that some kinds of
pharmacological birth control should be as widely and easily available as condoms,
or we might think that for various reasons (control of side effects, picking a method
from a wider array of choices, including ones that involve a minor surgical
procedure, better promotes choice and safety) it is an all-things-considered better
policy to provide it via the available medical infrastructure.
Moreover, insofar as medicine provides effective solutions to what troubles us,
medicalization may simply serve the purpose of implicitly designating who has the
skill or technology to intervene. This can come together with certification of those
who provide those solutions – qualified doctors. Certification is not uncommon in
different areas – for example, regulation and law may only permit qualified
electricians set up new electrical installations. Certification gives a
prima facie
reason to have a somewhat greater degree of confidence in a practitioner’s skill than
when no certification is present. It thus also brings a certain social benefit.
Another issue arises where medical professionals act as ‘gatekeepers’ and thus have
control over the access to technology. It is hard to say how this would play out in
the scenario of moral and social enhancement. Access to new reproductive
technologies, neuroscientific self-experimentation, as well as, for example, deep
brain stimulation depends on the the ability to find a medical professional that is
willing to provide the technology. This makes it a matter for the medical profession
and, despite some decline in the power of that profession, still involves dilemmas
related to the exercise of power and discretion by medical professionals
(Pacholczyk, 2011).
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The second question is about economy – how do we get what we want in a cheap,
easy and effective way which maximises benefits while offering the opportunity of
managing costs or side-effects. Providing birth control through medical
professionals may simply be the best way of maximising the benefits given the
social systems and structures currently in place (e.g. collective subsidising or
covering the cost, expert assistance in decision-making, managing and following up
on side-effects). While that may mean that birth control and the prevention and
remedying of sexually transmitted infections (STIs) is medicalized, this does not
prevent an individual from participating in the choice of non-medicalized birth
control methods or preventing STIs in non-medicalized ways, nor does it mean that
the sphere of our sexuality has been somehow washed off all other (i.e. non-
medical) meanings.
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