Medicalization

The current revival of interest in classic psychedelics and other psychoactives such as ketamine and MDMA, coupled with changes to their regulatory status in many jurisdictions, necessitates rigorous ethical guidelines both within and beyond clinical and scientific contexts. This paper examines crucial ethical, philosophical, and policy considerations needed to ensure psychedelic use across various settings remains equitable, beneficial, consensual, and safe, with appropriate accountability mechanisms for addressing potential harms. We seek to broaden the lens beyond the medical model of psychedelics (...) to include potentially valuable non-medical applications that could benefit individuals, communities, and society. With popular interest in psychedelics growing outside of therapeutic and research settings, there is a need to determine which aspects of any proffered guidelines, or underlying principles, should be applied similarly across contexts and in what ways there should be flexibility and/or context-sensitivity in their interpretation or application. In developing such guidelines, we suggest the “treatment versus enhancement” distinction – and associated debates familiar from bioethics and philosophy of medicine – requires renewed attention. We argue that neglecting non-medical and broad scientific use cases for psychedelics may have important implications for a range of ethical issues surrounding psychedelic use and research, including concerns about psychedelic hype and exceptionalism (both positive and negative), therapeutic touch, informed consent, data-gathering, and balancing access and safety. We conclude with suggestions for future directions in research and policy in the burgeoning area of psychedelic bioethics, stressing the importance of incorporating the perspectives of a diversity of stakeholders and fostering cross-sector collaboration. (shrink)

The concept of women-centered care during pregnancy and childbirth has received increasing attention. It addresses the question of the right degree of medical care during pregnancy. Consequently, it further opens a debate about the medicalization of pregnancy, which puts pregnancy into the realm of medicine and treats it as a medical problem. The experience of pregnancy and childbirth plays an essential role in the well-being of both the mother and the future child and is influenced by women’s autonomy and freedom (...) of choice. The aim of this study is to explore the perceptions and perspectives of women on the medicalization of pregnancy and childbirth. The study illuminates the women’s belief about whether pregnancy and childbirth should be a medicalized process to a greater or lesser degree, focusing on their preferred models of care and the implications for healthcare providers. In-depth interviews with 37 women of various backgrounds and experiences were conducted as part of a national qualitative study in Switzerland. A thematic analysis identified key themes and patterns. Two important aspects related to women’s autonomy emerged: the possibility of defining and positioning pregnancy and childbirth according to their own beliefs and life practices, and the freedom to choose the preferred model of care for their pregnancy. The findings suggest that healthcare providers should offer personalized models of care and support women’s specific needs, ensuring genuine choice and integrating authentic informed consent into the decision-making process. (shrink)

The medicalization of risk rests on foundational assumptions shared by economics and public health. Economists, however, think in terms of pursuing an array of goods, and hence, they offer useful critiques of the irrationality involved in trying to subordinate all goods to one narrow good, like avoiding death from a particular disease. Many of our approaches to health do not appear to be fully rational, suggesting that the deeper motivation lying behind our concerns about health are to be found in (...) something other than the impulse to extend human lives as much as possible. This paper draws on the theology of St. Thomas Aquinas to sketch a richer way of thinking about the goods we pursue in health care that can help us to avoid the pitfalls associated with the medicalization of risk. (shrink)

Suicide is a leading cause of death in the United States and in many other parts of the world. As such, suicide is frequently framed as a medical and public health problem for which solutions are best recommended by medical and public health authorities. While, medicalized suicide prevention strategies often resonate with traditional Christian commitments to preserve life and to discourage suicide, there is little evidence to date that medical approaches to suicide risk-reduction decrease population rates of suicide. Further, by (...) treating suicide as a phenomenon that can be eliminated through technical managerial control, modern suicide prevention efforts construe suffering persons as carriers of risk best managed by standardized and often dehumanizing environments of care. This emphasis on the medical management of risk also erodes the clinician–patient relationship and inappropriately centers medical (e.g., systematic health screenings) rather than non-medical (e.g., access to housing) forms of response. Although, medicalized suicide prevention efforts should not be dismantled, those working to prevent suicide would do well to prioritize a positive commitment to human dignity and worth and to engage social and political systems beyond medicine and public health, while drawing on specific contributions that clinicians can offer. (shrink)

The day has arrived that genetic tests for educational outcomes are available to the public. Today parents and students alike can send off a sample of blood or saliva and receive a ‘genetic report’ for a range of characteristics relevant to education, including intelligence, math ability, reading ability, and educational attainment. DTC availability is compounded by a growing “precision education” initiative, which proposes the application of DNA tests in schools to tailor educational curricula to children’s genomic profiles. Here I argue (...) that these happenings are a strong signal of the geneticization of education; the process by which educational abilities and outcomes come to be examined, understood, explained, and treated as primarily genetic characteristics. I clarify what it means to geneticize education, highlight the nature and limitations of the underlying science, explore both real and potential downstream bioethical implications, and make proposals for mitigating negative impacts. (shrink)

Moralising accounts of depression include the idea that depression is a sin or the result of sin, and/or that it is the result of demonic possession which has occurred because of moral or spiritual failure. Increasingly some Christian communities, understandably concerned about the debilitating effects these views have on people with depression, have adopted secular folk psychiatry’s ‘medicalising’ campaign, emphasising that depression is an illness for which, like (so-called) physical illnesses, experients should not be held responsible. This paper argues that (...) both moralising and medicalising models of depression are intellectually and practically (pastorally and therapeutically) problematic, gesturing towards more promising emphases. (shrink)

Prior research has unveiled a pathologization effect where individuals perceived as having bad moral character are more likely to have their conditions labeled as diseases and are less often considered healthy compared to those viewed as having a good moral character. Moreover, these individuals are perceived as less unlucky in their affliction and more deserving of it. This study explores the broader impacts of moral character on such judgments, hypothesizing that these effects reach deeper and extend to both negative and (...) positive moral evaluations. The pathologization effect also raises concerns about potential discrimination and the overmedicalization of normal health variations, so we also examine whether providing more detailed descriptions of conditions mitigates the influence of judgments of moral character. The methodology and broader implications of our findings are discussed, emphasizing the need for a deeper understanding of how moral judgments might influence patient care. (shrink)

The Brussels Collaboration on Bodily Integrity (BCBI)’s (2025) critique of genital modifications in prepubescent minors opposes the common practice of genital surgeries on intersex children except...

Intersex individuals—those whose physical sex characteristics do not align with conventional male or female categories—encounter considerable challenges within healthcare systems, which often medicalize their bodies through invasive treatments aimed at “normalizing” their traits. This narrative review synthesizes key contributions from medical sociology, medical anthropology, and gender studies to examine the social processes that define, regulate, and often marginalize intersex identities in clinical contexts. Drawing on theoretical frameworks such as medicalization, biopower, stigma theory, intersectionality, and structural violence, the paper situates intersex (...) healthcare within broader systems of normativity and control. It critiques the historical and contemporary role of healthcare institutions in reinforcing binary understandings of sex and gender, often at the cost of individual autonomy and psychosocial well-being. Comparative analyses with transgender healthcare reveal both shared and divergent mechanisms of institutional gatekeeping, underscoring the need for a justice-oriented, intersectional approach to care. This work ultimately advocates for systemic change in both healthcare delivery and policy, informed by sociological insight and intersex-led activism, emphasizing dignity, self-determination, and epistemic inclusion. (shrink)

This paper considers whether assisted suicide and euthanasia (AS/E) is an area for medical regulation or whether there is a better alternative regulatory mechanism to govern it. Drawing from empirical evidence across a range of jurisdictions where it is legalized, the paper argues that there are at least four good reasons to consider demedicalizing AS/E: (1) pragmatic ethical issues of infrastructural weakness in AS/E service provision in already overstretched healthcare systems globally; (2) challenges of medicalization; (3) regulatory complexities concerning medical (...) law (including pharmaceutical law) and criminal law; (4) the risk that AS/E becomes more easily susceptible to healthcare economics. The paper suggests several recommendations concerning a possible “demedicalized model.”. (shrink)

The concept of women-centered care during pregnancy and childbirth has received increasing attention. It addresses the question of the right degree of medical care during pregnancy. Consequently, it further opens a debate about the medicalization of pregnancy, which puts pregnancy into the realm of medicine and treats it as a medical problem. The experience of pregnancy and childbirth plays an essential role in the well-being of both the mother and the future child and is influenced by women’s autonomy and freedom (...) of choice. The aim of this study is to explore the perceptions and perspectives of women on the medicalization of pregnancy and childbirth. The study illuminates the women’s belief about whether pregnancy and childbirth should be a medicalized process to a greater or lesser degree, focusing on their preferred models of care and the implications for healthcare providers. In-depth interviews with 37 women of various backgrounds and experiences were conducted as part of a national qualitative study in Switzerland. A thematic analysis identified key themes and patterns. Two important aspects related to women’s autonomy emerged: the possibility of defining and positioning pregnancy and childbirth according to their own beliefs and life practices, and the freedom to choose the preferred model of care for their pregnancy. The findings suggest that healthcare providers should offer personalized models of care and support women’s specific needs, ensuring genuine choice and integrating authentic informed consent into the decision-making process. (shrink)

There are many concepts of fatherhood.The question of paternity intertwines three core perspectives on what makes a man a father: while social fatherhood is based on the idea of paternal care for a child, biological fatherhood is rooted in the genetic relationship between a man and the child conceived through his germ cell. Almost perpendicular to this is legal paternity, which links fatherhood to the exercise of parental rights, which can be acquired through legal actions such as marriage, recognition, court (...) determination, or adoption. The aim of this essay is to briefly overview the development of paternity testing within (forensic) medicine since the early modern period. The basic proposition is that the idea of the father has been biomedicalised since early modernity, meaning that paternity has increasingly been expressed in biological and medical terms and that medical experts have gained a crucial role in determining paternity. The text illustrates how closely the concept of biological fatherhood is linked to prevailing theories of conception and (biological) inheritance, and how these theories have shaped forensic methods for establishing paternity. Simultaneously, it is shown how legal development and medical examination interacted as mutually influential factors in the advancement of paternity determination techniques. To highlight these interactions, the text examines the case of Germany where paternity testing became crucial during the Nazi regime and its laws on inheritance. It is argued that paternity was initially invisible and recognisable only through acknowledged sexual intercourse with a woman or marriage on paper; it became visible first through characteristic traits and then retreated into invisibility again, this time in the realm of the molecular, concealed behind abstractions and symbols. The place of evaluation shifted from the courtroom to the laboratory. (shrink)

The social relationships between humans and our closest nonhuman species (e.g., dogs, cats, and horses) are complex and subject to change. This complexity contradicts the popular phenomenon of using these animals in medical interventions for mental health (i.e., animal assisted therapy). This article uses anthropological research and ethnographic examples from the Central Coast, Australia, to exemplify the conflicts, contradictions, and realities of our companion animals’ relationship to human mental health. Using a phenomenological perspective, the article examines the complex realities in (...) which companion animals (being living, fluctuating, mortal creatures) experience trauma, respond to human behaviors, and ultimately change throughout their lives, making them less “manageable” as mental health support while still valuable as a longer-term relationship. Companion animals maintain an extremely important position in the emotional lives of their human companions. However, their position in human worlds has purpose beyond therapeutic utility. Future research and use of companion animals for mental health purposes should carefully reconsider the implications of using living creatures in medical models and instead seek to better understand how our companion animals allow humans to access alternate ways of thinking throughout their lives. (shrink)

The article investigates the ethical and philosophical challenges posed by the integration of artificial intelligence in vascular surgery. Based on systematic data analysis and an interdisciplinary approach, the authors evaluate key AI advances, including personalization of treatment, automation of diagnosis, and prediction of complications. Particular attention is paid to the problems of accountability for algorithm decisions, transparency of “black box” systems, dehumanization of medicine, and cyborgization. The contradictions between technological efficiency and preservation of humanitarian values are revealed. The study emphasizes (...) the need for legal, educational and ethical mechanisms for the harmonious implementation of AI, where the doctor remains the central figure in the system “human-algorithm-patient” // Статья посвящена исследованию этических и философских вызовов, возникающих при интеграции искусственного интеллекта в сосудистую хирургию. На основе систематического анализа данных и междисциплинарного подхода авторы оценивают ключевые достижения ИИ, включая персонализацию лечения, автоматизацию диагностики и прогнозирование осложнений. Особое внимание уделено проблемам ответственности за решения алгоритмов, прозрачности «черных ящиков», дегуманизации медицины и киборгизации. Раскрыты противоречия между технологической эффективностью и сохранением гуманитарных ценностей. Исследование подчеркивает необходимость правовых, образовательных и этических механизмов для гармоничного внедрения ИИ, где врач остается центральным звеном в системе «человек-алгоритм-пациент». (shrink)

Medicalization is an important theory that has been subject to numerous debates. Drawing on three varied datasets, we forward a relational approach to medicalization that responds to critiques while aiming to reinvigorate the theory with new concepts and questions. In contrast to prior process-based work, our relational approach argues that medicalization is best understood as an action or activity undertaken by specific groups or actors. We further suggest that unequal relations characterize medicalization. Specifically, we argue that 1) groups or actors (...) receive a benefit from participating in medicalization, which we call the medicalizing dividend and, 2) an actor/group occupies a hegemonic position in medicalizing relations, reaping the largest dividend and constraining other actors. While we assert that pharmaceutical companies are currently hegemonic, we argue that their hegemony is not indefinite. We discuss how our approach facilitates links between medicalization and other theories, while outlining future steps for medicalization research. (shrink)

Sexuality plays a central role in Foucault’s philosophy, from his four volume series on the topic to his ideas about medicalization, biopower, and the abnormal. Many of Foucault’s concepts, such as governmentality, biopower, and biopolitics, are useful for analyzing the effects of laws and policies regulating reproduction and sexuality. This article brings Foucault’s ideas to bear on two aspects of sexuality, reproduction and trans health care, to show how the operations of biopower result in reproductive oppression. We briefly trace the (...) history of the professionalization of medicine and the correlative shift in control over reproduction from midwives to doctors. Next we examine the issue of forced or coerced sterilization of people deemed “unfit” to reproduce; for example, those with cognitive or physical disabilities, non-whites, and poor people, exemplifying how biopolitics is a normalizing force. Biopolitics and normalization permeate trans healthcare as well, pathologizing trans people as deviant in order for them to be able to access gender affirming health care and imposing norms based on binary and stereotypical gender categories and whiteness resulting in a restrictive transnormativity. Trans reproduction is subject to passive eugenics which makes sterility a requirement for transition related care. We demonstrate how reproductive oppression harms those who are not cisgender, heterosexual, cognitively and physically abled, and white; sex and biological reproduction are at the center of these processes of reproducing white, middle class workers in dyadic heterosexual family relations to perpetuate a ‘productive’ capitalist system. We conclude by discussing the ways that active and passive eugenics work together in reproducing heteronormativity, the interimbrication of whiteness and heteronormativity, and the implications for citizenship, immigration, and population control in service to the nation-state. (shrink)

Based on critical discourse analysis of Canada's Muskoka Initiative (2010–15), this article outlines how medicalisation contributes to the depoliticisation and technocratisation of global maternal health, while reinforcing patterns of reproductive stratification. By constructing maternal health as a problem of managing medicalised risk, the Muskoka Initiative was able to position family planning as a risk-minimising practice that can improve health by averting pregnancy among populations deemed high risk. Interpreting this construction through the lenses of reproductive justice and biopolitics, I argue that (...) this construction contributes to reproductive stratification and exemplifies how medicalised discourses have replaced overt discourses of population control within development policy, while continuing to discourage reproduction among racialised women in the Global South. (shrink)

Background Potential clinical interventions to mitigate or eliminate symptoms of Down syndrome (DS) continue to be an active area of pre-clinical and clinical research. However, views of members of the DS community have yet to be fully explored.Methods We conducted a survey with parents/caregivers of people with DS (n = 532) to explore interest in potential therapeutic approaches during fetal development or childhood that may improve neurocognition and modulate the DS phenotype. We qualitatively analyzed open-ended responses.Results Some respondents rejected the (...) development of therapies for DS categorically as being fundamentally ableist and promoting the erasure of diverse individuals. Many reflected tensions between the desire to improve quality of life and an aversion to erasure of a child’s personality.Conclusion Findings suggest that views on identity, personality, and disability may influence the acceptance of new interventions, especially if they are thought to mitigate positive attributes of the phenotype or negatively influence social acceptance of people with DS. (shrink)

The text analyzes fatphobia as a systemic oppression rooted in social and economic norms. Fat activism, which emerged in the 1970s in the United States, challenges the medicalization and stigmatization of non-normative bodies. In France, the movement remains limited due to the lack of translations of foundational texts. Three main types of writings dominate: personal narratives, weight-loss guides, and activist critiques. The text criticizes traditional medical and feminist approaches, favoring an intersectional perspective. It highlights the importance of personal testimonies in (...) making this form of discrimination visible. (shrink)

Stratified biomedicalization (Clarke et al., 2003, 2010) is a notion derived from Science and Technology Studies (STS) that refers to the complex ways in which biomedical implementations are distributed, often unintentionally, in an uneven manner between people because of their social class, gender, ethnicity, or race, which aggravates health inequities. Hence, although it is suggestive, the category is inadequate when considering the Global South. In this chapter I point out the limitations of this notion and suggest the concept of aspirational (...) biomedicalization with the purpose of showing how stratification joins the aspirations of the government to apply public policies from the Global North, which affect those who receive said policies. This conceptual proposal stems from my empirical work done in Mexico about the sociotechnical complexities of the implementation of public policies regarding preventive vaccination against human papillomavirus (HPV) and pre-exposure prophylaxis (PrEP) to prevent human immunodeficiency virus (HIV). Thus, in this text I offer a theoretical alternative to critically consider the way in which social contexts of the Global South can contribute to the creation of new concepts for STS. (shrink)

This study investigates the influence of evaluative judgments, specifically regarding an individual's moral character, on judgments of health and disease. Though it might seem that assessments judgments of health and disease should be impervious to evaluative judgments, two hypotheses suggest that health and disease judgments might be influenced by evaluative judgments: the "naturalization hypothesis" which centers on our inclination to assign blame, and the "pathologization hypothesis" rooted in the belief of a just world. These hypotheses lead to opposing predictions about (...) how someone with a perceived negative moral character might have their condition categorized. Employing a fictional vignette and the methodologies of experimental philosophy, our research provides evidence in favor of the "pathologization hypothesis." While this phenomenon likely carries real-world implications, especially in healthcare, it also has potential for offering insights into the dynamics of medicalization and stigma. (shrink)

Debates about the genuine disease status of controversial diseases rely on intuitions about a range of factors. Adopting tools from experimental philosophy, this paper explores some of the factors that influence judgments about whether low sexual desire should be considered a disease and whether it should be medically treated. Drawing in part on some assumptions underpinning a divide in the literature between viewing low sexual desire as a genuine disease and seeing it as improperly medicalized, we investigate whether health and (...) disease judgments are affected by factors such as an individual’s gender, the cause of the low desire, whether the desire is high or low, and both personal and societal valuations of the condition. Our main findings indicate that (a) the cause of a condition influences whether it is judged a disorder, (b) how the individual values the condition influences whether the condition is seen as a proper target of medical intervention, and (c) perceived dysfunction influences judgments regarding health, disorder classification, medicalization, and medical intervention. Our findings help further illuminate the intricate interplay of factors that influence judgments about health and disease in controversial conditions. (shrink)

Debates about the genuine disease status of controversial diseases rely on intuitions about a range of factors. Adopting tools from experimental philosophy, this paper explores some of the factors that influence judgments about whether low sexual desire should be considered a disease and whether it should be medically treated. Drawing in part on some assumptions underpinning a divide in the literature between viewing low sexual desire as a genuine disease and seeing it as improperly medicalized, we investigate whether health and (...) disease judgments are affected by factors such as an individual’s gender, the cause of the low desire, whether the desire is high or low, and both personal and societal valuations of the condition. Our main findings indicate that (a) the cause of a condition influences whether it is judged a disorder, (b) how the individual values the condition influences whether the condition is seen as a proper target of medical intervention, and (c) perceived dysfunction influences judgments regarding health, disorder classification, medicalization, and medical intervention. Our findings help further illuminate the intricate interplay of factors that influence judgments about health and disease in controversial conditions. (shrink)

In China, a prominent case exists wherein a medically fit woman filed a lawsuit against a hospital for denying her request to undergo oocyte cryopreservation. She contended the hospital had infringed upon her rights. This paper focuses on medicalization and gender equality to discuss whether or not a hospital can infringe upon a woman's rights. We believe elective oocyte cryopreservation is not a medical treatment and it may lead to an overwhelming utilization of extensive medical resources. Reproductive medicine may face (...) the risk of resource commercialization due to the practice of selective egg freezing. There are physiological disparities between males and females. The ability of men to cryopreserve sperm does not necessarily extend to a woman's capacity for oocyte cryopreservation. We contend that the application of this technology should continue to adhere to the principle of prudence. (shrink)

Medicalization occurs when a phenomenon comes to be subject to medical study, diagnosis, treatment, or prevention. Whether a phenomenon ought to be medicalized should be decided on a case-by-case basis. Recent moves to remove “bereavement exclusions” from psychiatric diagnostic manuals and to introduce grief-specific medical disorders have elicited criticisms from skeptics about grief’s medicalization, but these criticisms can largely be blunted. This article first clarifies the nature of disputes about medicalization, highlighting how these disputes do not concern whether a condition (...) such as grief is clinically significant or whether it can generate illness, but whether the condition itself is rightfully categorized as potentially pathological. It then offers a stronger, philosophically grounded case against the medicalization of grief, resting on how medicalizing grief is likely to detrimentally alter the moral and political meanings attached to grief. Specifically, medicalizing grief will “normativize” a medical vocabulary for evaluating grief that may impede authentic engagement with grief, validate a suspect “time slice” model of human well-being that overlooks how grief can benefit a person’s life as a whole, and impede desirable sympathy or solidarity with grieving persons. (shrink)

This paper draws on qualitative research using focus groups involving 38 general practitioners (GPs). It explores their attitudes and feelings about (over-)medicalisation. Our main findings were that GPs had a complex representation of (over-)medicalisation, composed of many professional, social, technological, economic and relational issues. This representation led GPs to feel uncomfortable. They felt pressure from all sides, which led them to question their social roles and responsibilities. We identified four main GP-driven proposals to deal with (over-)medicalisation: (1) focusing on the (...) communication in doctor–patient relationships; (2) grounding practices in evidence-based medicine; (3) relying on clinical skills, experience and intuition; and (4) promoting training, leadership bodies and social movements. Drawing on these proposals, we identify and discuss five paradigms that underpin GPs’ attitudes toward (over-)medicalisation: underlying social factors, preventing medicalisation, managing uncertainties, sharing medical decision-making and thinking about care as a rationale. We suggest that these paradigms constitute a defensive posture against GPs’ uncomfortable feelings. All five defensive paradigms were identified in our focus groups, echoing contemporary political debates on public health. This non-exhaustive framework forms the outline of what we call _ordinary defensive medicine_. GPs’ uncomfortable feelings are the origin of their defensive solutions and the manifestation of their vulnerability. This professional vulnerability can be shared with the patient’s vulnerability. In our view, this creates an opportunity to rediscover patient–doctor relationships and examine patients’ and doctors’ vulnerabilities together. “There are many cases in which—though the signs of a confusion of tongues between the patient and his doctor are painfully present—there is apparently no open controversy. Some of these cases demonstrate the working of two other, often interlinked, factors. One is the patient’s increasing anxiety and despair, resulting in more and more fervently clamouring demands for help. Often the doctor’s response is guilt feelings and despair that his most conscientious, most carefully devised examinations do not seem to throw real light on the patient’s “illness”, that his most erudite, most modern, most circumspect therapy does not bring real relief.” (Balint M. The Doctor, His Patient and the Illness. New York: International Universities; 2005. [1957].) “Theories about care put an unprecedented emphasis on vulnerability—taking up that challenge to transform what really counts in today’s hospitals implies letting colleagues inside previously closely guarded professional boundaries” (2, our translation). (shrink)

This paper draws on qualitative research using focus groups involving 38 general practitioners (GPs). It explores their attitudes and feelings about (over-)medicalisation. Our main findings were that GPs had a complex representation of (over-)medicalisation, composed of many professional, social, technological, economic and relational issues. This representation led GPs to feel uncomfortable. They felt pressure from all sides, which led them to question their social roles and responsibilities. We identified four main GP-driven proposals to deal with (over-)medicalisation: (1) focusing on the (...) communication in doctor–patient relationships; (2) grounding practices in evidence-based medicine; (3) relying on clinical skills, experience and intuition; and (4) promoting training, leadership bodies and social movements. Drawing on these proposals, we identify and discuss five paradigms that underpin GPs’ attitudes toward (over-)medicalisation: underlying social factors, preventing medicalisation, managing uncertainties, sharing medical decision-making and thinking about care as a rationale. We suggest that these paradigms constitute a defensive posture against GPs’ uncomfortable feelings. All five defensive paradigms were identified in our focus groups, echoing contemporary political debates on public health. This non-exhaustive framework forms the outline of what we call ordinary defensive medicine. GPs’ uncomfortable feelings are the origin of their defensive solutions and the manifestation of their vulnerability. This professional vulnerability can be shared with the patient’s vulnerability. In our view, this creates an opportunity to rediscover patient–doctor relationships and examine patients’ and doctors’ vulnerabilities together.“There are many cases in which—though the signs of a confusion of tongues between the patient and his doctor are painfully present—there is apparently no open controversy. Some of these cases demonstrate the working of two other, often interlinked, factors. One is the patient’s increasing anxiety and despair, resulting in more and more fervently clamouring demands for help. Often the doctor’s response is guilt feelings and despair that his most conscientious, most carefully devised examinations do not seem to throw real light on the patient’s “illness”, that his most erudite, most modern, most circumspect therapy does not bring real relief.” (Balint M. The Doctor, His Patient and the Illness. New York: International Universities; 2005. [1957].)“Theories about care put an unprecedented emphasis on vulnerability—taking up that challenge to transform what really counts in today’s hospitals implies letting colleagues inside previously closely guarded professional boundaries” (2, our translation). (shrink)

In recent years, an array of critical emotion theorists have emerged who call for change with respect to how emotion theory is done, how emotions are understood, and how we do emotion. In this chapter, I draw on the work that some of these authors have produced to analyze how emotional marginalization of trans and disabled identities is experienced, considering in particular how this emotional marginalization results from the long history of pathologization of trans and disabled people. The past and (...) current pathologization of trans and disabled people is produced through normative assumptions, values, and beliefs that uphold systems of normalcy, including assumptions, values, and beliefs about how we feel and express emotions. In order to examine these issues, I identify three different stages at which emotional marginalization may take place: emotion experience, emotional display, and emotion recognition. In other words, emotional marginalization of trans and disabled people can occur at any of these stages. The central concern of my chapter is thus to show how emotional marginalization, at each of these stages, affects trans and disabled people. (shrink)

Employing critical discourse analysis (CDA), this paper examines how medicalized concepts of mental illness and paternalistic views are framed and used in the legal case, Thompson and Empowerment Council v. Ontario (2013). The paper argues that the case utilizes a pathologized notion of mental illness to justify and defend the legality of involuntary treatment, specifically, the community treatment orders (CTOs) under Ontario’s Mental Health Act (MHA). This paper shows how the Thompson case relies on medical reductionism and binary notions of (...) capacity versus incapacity while failing to consider intersecting factors and contextual and social determinants of psychosocial disability. Following this, I suggest that a postmodernist relational theory of disability could change the legal discourses about the MHA. Challenging the medicalized view of mental illness through the relational approach to psychosocial disability could have strengthened the plaintiffs’ case and prompted legal reforms for better safeguards under the MHA. In doing so, this paper offers a basis and future direction for legal reforms that can lead to legal mandates for improved social and healthcare services to enhance the autonomy of individuals subjected to CTOs. (shrink)

Gender dysphoria is typically construed as a medical concept. This understanding of gender dysphoria reflects how cisgender people interpret trans experience. This essay proposes an alternative concept of gender dysphoria for critical theory: on this account, gender dysphoria is alienation from cisgender forms of life. If the medicalized concept of gender dysphoria tacitly takes for granted, identifies with, and thereby reinforces cisgender patriarchal society, a critical theory of gender dysphoria instead approaches the issue from the perspective of trans people, their (...) lived experiences and social situation, to offer a critique of society. While the medicalized concept of gender dysphoria refers to a “distress” caused by living in the “wrong-body,” the critical concept of gender dysphoria refers to an alienation as a result of living in the “wrong (cisgender patriarchal) society.” The critical concept of gender dysphoria may become a tool capable of describing the necessary facets of trans experience necessary to form a political coalition. The paper concludes by claiming that trans subjects are the gendered analogue of Marx’s concept of the proletariat. (shrink)

Background Scientific and technological advancements in mapping and understanding the interrelated pathways through which biological and environmental exposures affect disease development create new possibilities for detecting disease risk factors. Early detection of such risk factors may help prevent disease onset or moderate the disease course, thereby decreasing associated disease burden, morbidity, and mortality. However, the ethical implications of screening for disease risk factors are unclear and the current literature provides a fragmented and case-by-case picture. Methods To identify key ethical considerations (...) arising from the early detection of disease risk factors, we performed a systematic scoping review. The Scopus, Embase, and Philosopher’s Index databases were searched for peer-reviewed, academic records, which were included if they were written in English or Dutch and concerned the ethics of (1) early detection of (2) disease risk factors for (3) disease caused by environmental factors or gene-environment interactions. All records were reviewed independently by at least two researchers. Results After screening 2034 titles and abstracts, and 112 full papers, 55 articles were included in the thematic synthesis of the results. We identified eight common ethical themes: (1) Reliability and uncertainty in early detection, (2) autonomy, (3) privacy, (4) beneficence and non-maleficence, (5) downstream burdens on others, (6) responsibility, (7) justice, and (8) medicalization and conceptual disruption. We identified several gaps in the literature, including a relative scarcity of research on ethical considerations associated with environmental preventive health interventions, a dearth of practical suggestions on how to address expressed concerns about overestimating health capacities, and a lack of insights into preventing undue attribution of health responsibility to individuals. Conclusions The ethical concerns arising with the early detection of risk factors are often interrelated and complex. Comprehensive ethical analyses are needed that are better embedded in normative frameworks and also assess and weigh the expected benefits of early risk factor detection. Such research is necessary for developing and implementing responsible and fair preventive health policies. (shrink)

This dissertation is comprised of three chapters: -/- Chapter 1 intervenes in debates about the medicalization of grief, focusing on the recent addition of a grief-specific disorder – Prolonged Grief Disorder (PGD) – to the DSM. Opponents of medicalization have been primarily concerned with potential negative looping effects – ways that classificatory processes like medicalization (treating something as a disorder) contribute to harmful social practices or distortions of a person’s self-conception. Contrastingly, I call attention to unappreciated beneficial looping effects that (...) might be achieved by medicalizing (some) experiences of grief. Alongside this, I highlight that the concerns about negative looping effects rest on the philosophically significant and conceptually optional assumption that “normal” parts of human experience should not be medicalized. Consequently, I argue that rather than removing PGD from the DSM, the better path forward is to help grievers reconceive the role of diagnostic categories by moving away from a background understanding of health conditions as pathologies. -/- Chapter 2 develops an account of healthy grief as a constructive dialectical process – rather than either a state or a healing process aimed at “recovery”. On the account I develop, it is not a condition of healthy grief that it dissipates over time. Endless grief can be both appropriate and compatible with flourishing. In this respect, my account departs from various well-known accounts of grief (of which perhaps the most illustrious is Freud's in Mourning and Melancholia). In addition, my account sets itself apart from others in that it includes respect-for-the-lost-one as a central component of the dialectics of grieving. This move is pivotal, as it sets the stage for a picture of grieving on which grief is a positive component of living a flourishing life. In addition, the account I develop here has implications for our understanding of health, medicalization, and disorder; most notably it reinforces the case against conceptions of health that reduce health and human flourishing to merely the absence of pathology, dysfunction, or disease. -/- Chapter 3 extends the account of grief developed in the previous chapter to other forms of loss, with a particular focus on anticipatory grief. Considering multiple forms of loss elucidates two notable features of grief (i) object plenitude: in grief, there is never just one object of loss; the objects stand in intimate and overlapping relations with each other such that there are not always boundaries between them and (ii) object generation: the process of grieving partially determines which things are seen as losses. Having elucidated these features, I show how my account sheds light on some of the different ways that we can become “stuck” in our experiences of grief. Finally, I consider the practical (clinical, social, and interpersonal) upshots of my account. (shrink)

The most recent versions of official psychiatric diagnostic guidelines include a new addition: Prolonged Grief Disorder (PGD). PGD is controversial due to concerns about harmful looping effects. Some opponents of PGD’s inclusion in the DSM worry that the diagnosis may pathologize normal human experiences and alienate grievers from their grief. This paper argues that these concerns are less troubling than they initially appear (in part because they assume an unhelpful, and conceptually optional, background understanding of health conditions as pathologies) and (...) calls attention to overlooked beneficial looping effects that might be achieved by medicalizing (some) experiences of grief. (shrink)

New anti‐obesity medications (AOMs) have received widespread acclaim in medical journals and the media, but they also raise critical ethical, public health, and public policy concerns that have largely been ignored. AOMs are very costly, need to be taken by a patient in perpetuity (since significant rebound weight gain otherwise occurs), and threaten to shift resources and focus away from other crucial efforts at obesity treatment and prevention. Many people may feel less motivated to exercise or reduce their caloric consumption, (...) if they assume that obesity is now medically treatable. Policy‐makers may similarly come to feel that the solution to the obesity pandemic is simply to prescribe medications and that prevention efforts are far less necessary. These drugs raise concerns about justice (since AOMs will disproportionately benefit the wealthy), medicalization, and marketing. Policy‐makers, clinicians, and others need to engage in multipronged educational and policy efforts to address these challenges. (shrink)

Psychiatric language and concepts, and the norms they embed, have come to influence more and more areas of our daily lives. This has recently been described as a feature of the ‘psychiatrization of society.’ This paper looks at one aspect of psychiatrization that is still little studied in the literature: the psychiatrization of our emotional lives. The paper develops an extended account of emotion pathologizing as a form of affective injustice that is related to psychiatrization and that specifically harms psychopathologized (...) people, i.e., people who are socially perceived to be mentally ill. After introducing an initial account of emotion pathologizing as articulated in Pismenny et al. (2024), we extend the account by demonstrating how processes and practices of emotion pathologizing are informed by (1) the dominant biomedical approach to psychiatry and (2) sanism, a system of discrimination and oppression that disadvantages people who have received a psychiatric diagnosis, or are perceived as in need of psychiatric treatment. We then argue that emotion pathologizing can manifest as an affect-related hermeneutical injustice that disadvantages psychopathologized individuals by unfairly constraining how they make sense of and understand their own emotional experiences. (shrink)

ABSTRACT This article analyzes the politics of nostalgia’s history as a fatal disease between the seventeenth and nineteenth centuries, especially as it was applied to slaves in late eighteenth-century Cuba. I trace nostalgia’s medical history beginning with its inauguration in Swiss medicine in 1688, and then describe the contours of its transformation into a military disease primarily affecting white soldiers in France and the United States. Finally, I translate and analyze key elements of Francisco Barrera y Domingo’s work on nostalgia (...) as experienced by slaves in sugar mills in Havana. I show that Barrera uses his analysis of nostalgia and its treatment to describe the slaves’ harrowing conditions and homesickness. Nevertheless, in denying slaves the ability to return home and in failing to propose the abolition of the slave system in the wake of the Haitian Revolution, I argue, Barrera in fact deploys the diagnosis of nostalgia in order to medicalize and pathologize the slaves’ reactions and resistance to their captivity. Thus, despite his sympathy to the slaves, I conclude that for Barrera, nostalgia functions as a tool to better manage the slaves as laborers and as property. (shrink)

While the psychiatric perspective on pathologising vital cycles and processes, sexual diversity, and the stages of childhood life receives more and more rejection of their positions, the trend toward depathologisation as drifts in social movements and sociological, psychological, anthropological, and philosophical perspectives still does not offer practical solutions to mental illness and psychological suffering. The depathologising gaze, promoted not only by social movements or emerging disciplines—such as Mad Studies and child-centered philosophy—but also recently by traditional disciplines, has the harmful effect (...) of abandoning many suffering people, whose expectations in “Psy” professionals are vital to solving your real problems.How can one find a middle ground between these two tendencies?There’s not a simple answer to that problem. So, authors in this chapter propose a revision of the term pathos as a cultural object and its human implication. The question is linked with some of the foundational conceptions about the human being (Vygotski, Pensamiento y lenguaje. Editora Revolucionaria, 1926; Foucault, Naissance de la Clinique. Presses Universitaires de France, 1963; Canguilhem, Le normal et le pathologique. PUF, 1966) and its expressions (Deleuze, Las cartas del mal (13/1/1981) en Gilles Deleuze: En medio de Spinoza. Cactus, 1981).Culture, time, aesthetics, consciousness; continuity body-mind; instinct-pulsion, virtualisation, networks, and so on are some of the concepts revisited in this chapter to reframe the de question.Pathos, psychopathology, pathologisation, depathologisation, and mental health and illness are presented in this chapter as differentiated concepts with particular effects in each cultural context and referential frame, but particularly in each singular case (Forrester, Thinking in cases. Polity, 2017) as an empirical level for analysing the human nature (Foucault, Naissance de la Clinique. Presses Universitaires de France, 1963).Thus, a reframe of pathology and mental health is proposed, as a result of a new set of particular relationships, according to the formula opportunely analysed on Spinoza by Vygotski (Pensamiento y lenguaje. Editora Revolucionaria, 1926) and Deleuze (Las cartas del mal (13/1/1981) en Gilles Deleuze: En medio de Spinoza. Cactus, 1981), respectively. (shrink)

Critical psychiatry has recently echoed Szasz’s longstanding concerns about medical understandings of mental distress. According to Szaszianism, the analogy between mental and somatic disorders is illegitimate because the former presuppose psychosocial and ethical norms, whereas the latter merely involve deviations from natural ones. So-called “having-it-both-ways” views have contested that social norms and values play a role in _both_ mental and somatic healthcare, thus rejecting that the influence of socio-normative considerations in mental healthcare compromises the analogy between mental and somatic disorders. (...) This paper has two goals. Firstly, I argue that having-it-both-ways views fail to provide a compelling answer to Szasz’s challenge. The reason is that what is essential to Szasz’s argument is not that mental disorder attributions involve value judgements, but that mental attributions _in general_ do. Mental disorders are thus doubly value-laden and, _qua_ mental, only metaphorically possible. To illustrate this, I construe Szasz’s view and Fulford’s having-it-both-ways approach as endorsing two different kinds of expressivism about mental disorders, pointing out their different implications for the analysis of delusions. Secondly, I argue, against Szaszianism, that Szasz’s rejection of the analogy is relatively irrelevant for discussions about the appropriateness of medicalizing mental distress. Specifically, I draw from socio-normative approaches to the psychopathology/social deviance distinction and mad and neurodiversity literature to argue that a) it is still possible to distinguish social deviance from psychopathology once we reject the analogy; and b) that _both_ medicalizing and normalizing attitudes to mental distress can harmfully wrong people from relevant collectives. (shrink)

Smajdor and Rasanen (2024) argue that pregnant women are routinely denied appropriate treatment because pregnancy is seen as normal, and so they are denied ‘patient status’. They claim that formally classifying pregnancy as a disease may lead to better treatment for pregnant women. In this response, we argue that pathologising pregnancy and classifying all pregnant women as ‘diseased patients’ won’t reconfigure care in ways that benefit all women. Rather, it will likely only embolden the view that clinicians are entitled to (...) exercise jurisdiction over pregnant women and beget the increased use of medical intervention where it is not necessarily needed. (shrink)

Anchored in a decolonial framework, we understand race and gender as co-constructions of colonial modernity. Drawing on María Lugones’ concept of the colonial/modern gender system, we show that non-normative racialized trans subjects are pathologized through the imposition of a racial-colonial system of binary gender. We argue that coloniality, when adopted into the medical-psychiatric apparatus, takes shape as transnormativity: an individualized, medicalized form of trans identity which is rooted in a white, Western understanding of gender. Building on Jasbir Puar’s framework of (...) homonationalism and trans(homo)nationalism, and critiques of assimilationist queer politics through the lens of racial capitalism and anti-imperialism, we argue that trans(homo)nationalism is the absorption of transnormativity into the broader operations of state power, and see transnormativity as an extension of coloniality, operating as neo-colonialism. We argue that the political implications of trans(homo)nationalism include the sanctioning of violence against and the marginalization of non-normative and racialized trans subjects, and the continued imposition of a regime of racialized normative gendering. This assimilationist nationalist agenda is funneled through the for-profit medical-psychiatric apparatus wherein transition is co-opted into a curative, progress-based temporality. Looking to theorizations of trans temporality, we critique notions of linearity and futurity insofar as they bolster the deployment of racist, nationalist, imperialist state agendas. We articulate a vision for futurity grounded in a trans of color framework which resists assimilation into normativized gender, and call for truly radical futures for trans people which resist medicalized forms of trans identity which subscribe to the colonial, white, Western ideals of gender. (shrink)

This chapter examines the micropolitics of pathologization and depathologization in Chilean schools, focusing on ADHD diagnoses. Through ethnographic research in two schools, it explores how care intersects with medicalization, shaping the everyday lives of diagnosed children. While traditional critiques emphasize the pathologizing effects of medicalization, this study argues for a nuanced view that considers diagnosis as a “matter of care.” The research highlights how diagnoses function not just as labels but as tools that can both constrain and empower children. By (...) contrasting the practices of two schools—one enforcing conformity and the other supporting individual needs—the chapter reveals the dual nature of diagnoses as both medical and care-oriented technologies. It concludes by advocating for a careful approach to diagnosis, recognizing its potential to foster inclusion while remaining cautious of its capacity to stigmatize. This analysis contributes to discussions on the ethics of care and the role of educational institutions in mental health. (shrink)

This open access book is an integrated historical and philosophical investigation of several problematic situations that emerge from diverse areas of medical practice. These include (but are not limited to): Paying less attention to patients who are suffering with symptoms because no identifiable pathological lesion or pathophysiological process can be found. Paying too much attention to patients who are not suffering with symptoms because pathological lesions or pathophysiological processes have been found. The tendency to understand patients at risk of developing (...) pathology as being diseased. The tendency to disregard the importance of wider societal consequences of definitions of disease and health. The book shows that many of these problems are related to what disease and health are considered to be and argues that these problems can be addressed by reconsidering the concepts of health and disease employed in practice. It argues for a pragmatic reconceptualization of health and disease that allows clinicians, researchers, and lay people to understand health and disease in many ways, depending on the specific context in which they find themselves and the problems they are trying to solve. In doing so, authors are careful to show how this pragmatism does not endorse “silly” forms of relativism, in which knowledge is reduced to belief or to whatever people find expedient to believe. This work is relevant for philosophers and historians a well as for doctors, health policy makers and other health professionals because it addresses problems sourced from medical practice, albeit using philosophical and historical methods. (shrink)

Same-sex practices are commonly medicalised in various global spaces. Some societies view same-sex practices as some form of disease that needs to be cured. In Africa, the influence of Christianity has prompted many communities to conclude that there are spiritual forces behind same-sex orientations and practices. Therefore, same-sex practices are demonised, and those identifying with these sexualities and gender identities are viewed as sick, or as having some form of mental illness. As a fast-growing and influential movement in South Africa, (...) Christianity plays a critical role in this narrative. Against this backdrop, this article examined how some Pentecostal pastors in South Africa use God-talk to propel the narrative that medicalises same-sex practices and how these pastors claim to have miraculous powers to heal these practices. Consequently, the gender and sexuality commonly accepted within African religiosity and spirituality are pushed to the peripheries. Therefore, it is argued in this article that the colonial-missionary discourses regarding African sexualities and genders are at play within the religious medicalisation of same-sex narratives. Thus, there is a need to problematise and transform this narrative. This act can contribute to delinking African genders and sexualities from Western repressions and subjugation agendas. The discussion moved from the premise of decoloniality while adopting a multidisciplinary approach that incorporated theology, gender and sexuality studies, psychology, health, and socio-political sciences. Again, the article used secondary literature analysis to examine this phenomenon and to gain a thorough understanding of how African Pentecostalism continues to use God-talk to medicalise same-sex practices in contemporary South Africa and the repercussions thereof. Contribution: The study contributed to the existing knowledge that addresses religious challenges faced by people identifying with non-normative sexualities and genders in Africa. This can contribute to the transformation of religious medicalisation of same-sex practices in South Africa, and elsewhere. (shrink)

Este artículo se concentra en la recepción y el legado de Michel Foucault en el ámbito estadounidense, en particular en la Universidad de California, Berkeley (1980-1981 y 1983). Durante ese último año, Foucault formó un seminario de investigación dedicado a esbozar los primeros trazos de una “genealogía del biopoder”. Los trabajos en Berkeley tocaron diversos ejemplos. Sin embargo, ninguno de ellos fue directamente relacionado con lo que, sostengo, describe mejor el funcionamiento contemporáneo del biopoder; esto es, el dispositivo médico-sanitario, o (...) la “medicalización”. Se parte de dos premisas principales: (1) bajo el marco de una discusión acerca de los diversos usos del concepto de biopoder, busco poner de relieve su extraordinario potencial histórico crítico para comprender qué está pasando en este preciso momento; en otras palabras, abonar a eso que Foucault entendió por una “ontología de la actualidad”. (2) Hacer notar que es casi imposible comprender el funcionamiento de esta modalidad de ejercicio del poder sin la intervención del modelo médico, en la medida de su esfera de influencia en las sociedades actuales. Esto último se muestra en casos como el origen -y pervivencia- del Estado asistencial (welfare), los experimentos de eugenesia, las técnicas de reproducción asistida, las políticas públicas de combate a la propagación viral y el consiguiente “temor al contagio” poblacional, la explotación indiscriminada de los alimentos transgénicos y -de manera un poco más prolija-el papel de la medicina genómica preventiva. (shrink)