Beyond Treatment

There is a tendency in our culture to categorize issues and fit them into neat little boxes.

For example, poverty is a social issue, or it is an issue of individuals being lazy, incompetent, or having some other character flaw which entails that they deserve to suffer. On the flip side, Diabetes, Cancer, etc. are medical issues which require treatment to enable those individuals suffering from their affliction to gain some relief and be able to live their life at some normal standard. This is rampant: social issues such as racism, sexism, poverty, etc. get placed on individuals and are therefore individual problems to solve or if that is not the case they are deemed as unsolveable due to the time/economic cost/manpower it would require to attempt a fix. Conversely, medical issues (at least in the Canadian context) are unfortunate happenstances that need to be solved and which the community rallies to support even if there is push back due to the time/economic cost/manpower it requires to solve them. It is no wonder then, that in this climate anything that can be constructed as a medical issue rather than a social one will receive more community support and governmental funding. This then encourages the medicalization of a whole host of things from disability to mental health to homelessness and addiction.

“This is a good thing!” you say, “it means people get the help they need.”

But does it?

The Problem of Medicalization

I’ve talked in the past about how the dichotomy between medical and social models of disability causes problems. Today I want to look at the larger societal structures which encourage the medicalization of disability along with other issues such as mental health & neurodivergence.

The ideology of medicalization does a number of things. First, it says “X is treatable through some kind of therapeutic intervention.” Second, it says, “X will be solved when Y is achieved.  Therefore, Y is our goal.” We can see this in fields like physiotherapy. If you have an injury, you will receive therapy to get back functionality and therapy will end whenever you gain back the ability to do whatever you were able to do before. However, physiotherapy will not for example help you achieve some mobility that you have never had that you want to achieve, even if your life might be improved by the ability (e.g. being able to bend down and touch your toes). It sets up some norm as the standard that we need to get everyone to and then says once that baseline is achieved the issue is solved.

The Erasure of Social Dimensions

Given the way the ideology of medicalization works, it excludes causes of harm that lie outside the body (excepting chemical/genetic factors), and denies multidimensional techniques to solve problems. For example, while mental illness has genetic factors and outcomes are often improved by medication- this does not explain the rise of anxiety & depression following the 2016 American election. Sometimes, there are external factors that initiate or exacerbate physiological issues. We see this even with what we think of as traditionally physical illnesses- if for some reason an individual is unable to access medication or treatment for social factors they will have worse outcomes.

However, the history of the matter is that medical treatment systems are a lot easier for politicians to pump money into than into social nets that provide individuals with a basic standard of living or into accessibility requirements for businesses which require costly overhauls and more importantly thought and consideration for individuals who navigate the world differently. However, despite medicalization being an effective avenue to gain funding to solve problems like mental illness, and disability, throwing money at a problem does not solve it unless the underlying issues are addressed and the underlying issues are not merely medical ones.

Changing Standards of Care

What would turning away from a medicalized ideology look like?

I think that the first thing it would entail would be a turn away from a model of social support that required clinical diagnoses to function, which would in turn require a rejection of the ideas that a) responding to needs is reactive vs. proactive and b) that individuals deserve assistance in developing new skills and ways of navigating the world.

Mental health is a really good example for this because it does involve medical treatment in some cases, but also includes social supports such as talk therapy. Imagine, however, if it also included things like: a society in which everyone could have a living wage and get adequate sleep? Or in which everyone could participate in a physical activity that made them feel good about being embodied? Or in which there were easily accessible and free classes on artistic expression? All of these things contribute to mental health and well-being, but they can’t exist only in a hospital or medicalized environment- supports for flourishing must be brought into communities.

Conversely, what if we started thinking about other medicalized issues in this way? What if treatment for diabetics wasn’t framed simply about having individuals not die and pumping them full of insulin and putting them on restrictive diets, but rather about enabling them to enjoy a range of experiences like food and exercise and ensuring that their bodies were able to be used in a plurality of ways?

I believe that if we re-framed our medical ideology in this way we would see better outcomes for physical illnesses too because it puts the emphasis not just on existence and health, but on capacity and flourishing. Furthermore, it would encourage innovation in areas where treatment doesn’t exist to restore, but rather the focus is on the maintenance or minimization of pain such as in palliative care. Instead of merely maintaining or minimizing pain there could be an additional push to find areas where joy and fulfillment could still exist by engaging medical care in a wider range of human experience and possibility.

Categorizing issues as either/or reduces the problem and makes it seem more manageable from a policy standpoint- but if an issue cannot be solved by only one dimensional treatment (and so few issues can be), then we are at risk of wasting valuable, limited resources. By thinking more holistically about the problems that we as a medical system, society, and people are faced with, we can improve outcomes for all groups and work towards a more integrated and accepting society.

Everyone has their own shit they’re dealing with. Everyone matters. Everyone deserves to flourish- whatever that looks like for them.

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