Mistaking the Map for the Territory: What Society Does With Medicine; Comment on “Medicalisation and Overdiagnosis: What Society Does to Medicine”

Document Type: Commentary

Author

University of Sheffield, Sheffield, UK

Abstract

Van Dijk et al describe how society’s influence on medicine drives both medicalisation and overdiagnosis, and allege that a major political and ethical concern regarding our increasingly interpreting the world through a biomedical lens is that it serves to individualise and depoliticize social problems. I argue that for medicalisation to serve this purpose, it would have to exclude the possibility of also considering problems in other (social or political) terms; but to think that medical descriptions of the world seek to or are able to do this is to misunderstand the purpose and function of model construction in science in general, and medicine in particular. So, if medicalisation is nonetheless used for the depoliticization described by many critics, we must ask what society does with medicine to give it this exclusive authority. I propose that the problem arises from a tendency to mistake the map for the territory, and think a tool to understand certain aspects of the world gives us the complete picture. To resist this process, I suggest health workers should be more open about the purpose and limitations of medicalisation, and the value of alternative descriptions of different aspects of human experience.

Keywords

Main Subjects


  1. van Dijk W, Faber MJ, Tanke MAC, Jeurissen PPT, Westert GP. Medicalisation and Overdiagnosis: What Society Does to Medicine. Int J Health Policy Manag. 2016;5(11):619-622. doi:10.15171/ijhpm.2016.121
  2. Walker MJ, Rogers W. Defining disease in the context of overdiagnosis. Med Health Care Philos. 2016. doi:10.1007/s11019-016-9748-8
  3. Wardrope A. Medicalization and epistemic injustice. Med Health Care Philos. 2014;18(3):341-352. doi:10.1007/s11019-014-9608-3
  4. Giere RN. An agent-based conception of models and scientific representation. Synthese. 2009;172(2):269-281. doi:10.1007/s11229-009-9506-z
  5. Parker WS. Scientific Models and Adequacy-for-Purpose. Mod Sch. 2010;87(3):285.
  6. Park H-J, Friston K. Structural and Functional Brain Networks: From Connections to Cognition. Science. 2013;342(6158):1238411. doi:10.1126/science.1238411
  7. Clark J. Medicalization of global health 1: has the global health agenda become too medicalized? Glob Health Action. 2014;7:23998. doi:10.3402/gha.v7.23998
  8. Calhoun C. Justice, care, gender bias. J Philos. 1988;85(9):451-463.
  9. Kidd IJ. Epistemic Injustice and Illness Bibliography. https://www.academia.edu/30136837/Epistemic_Injustice_and_Illness_Bibliography. Accessed February 12, 2017.
  10. Garry A. Medicine and medicalization: a response to purdy. Bioethics. 2001;15(3):262-269. doi:10.1111/1467-8519.00236
  11. Szmukler G. When psychiatric diagnosis becomes an overworked tool. J Med Ethics. 2014;40:517-520. doi:10.1136/medethics-2013-101761.
  12. Conrad P. Medicalization and Social Control. Annu Rev Sociol. 1992;18:209-232.
  13. Salmon P, Peters S, Stanley I. Patients’ perceptions of medical explanations for somatisation disorders: qualitative analysis. BMJ. 1999;318(7180):372-376. doi:10.1136/bmj.318.7180.372
  14. Hofmann B. Medicalization and overdiagnosis: different but alike. Med Health Care Philos. 2016;19(2):253-264. doi:10.1007/s11019-016-9693-6