Adam Blatner

Words and Images from the Mind of Adam Blatner


Originally posted on December 13, 2012

A friend, asking about what she called “arbitrary definitions of illness,” noted that they “pose a therapeutic challenge. As a society we also tend to medical-ize normal human conditions (like infertility). And what’s normal?” This got me thinking about the nature of “diagnosis.” Also, the word "medicalize" is interesting.
Sometimes diagnosis is one of the better things we can do as physicians, answering the feeling-filled question, What’s wrong with me? Am I just lazy? Oversensitive to my body? Making a big deal about nothing? Self -doubt is a form of mild pain. Should I have done something to prevent this? Am I weird, bad? No, no, this is a recognizable condition, happens sometimes. What will happen? Will I have this forever, will it get worse? What should we do? What will it cost me? Diagnosis is a major therapeutic gift.

Secondly, diagnosis sometimes helps doctors to think about, explore further, and then effectively treat various conditions. A good part of the history of medicine has involved improvements in diagnosis. (Example: Oh, this? This isn’t an infective disease: this is a nutritional deficiency.)

We should not overly generalize in criticizing “diagnosis” just because some foolish folks overdo it. Anyway, what might be some examples of what we seem to be “medicalizing” which should not be medicalized?

We should also note the socioeconomic use of diagnosis. Should medical insurance be used to cover which psychiatric conditions? It comes down to the use of diagnosis? Getting mad at your spouse? No. Habitually becoming enraged and going out of control and becoming violent? Yes.

I’m referring to the patient who says, “Well, I was never like this before, doc. Ever since that head injury in Afghanistan…”: Should we refuse to diagnose?

The issues involved are not to be taken lightly. Certainly we as a culture tend to offer diagnoses as ways of softening or disguising our judgments. At times moral judgments about deep wickedness tend to be too readily excused: “I wonder if something is "wrong" with her.”

Anyway, I asked my friend what she thought might be some examples of mistaken or misleading "medicalization." (I have noticed the trend towards turning nouns or adjectives into verbs, such as by adding “-ization” to medical….) She answered that some examples might include infertility, erectile dysfunction, premenopausal syndrome (PMS), or attention deficit hyperactive disorder (ADHD). Added to this have been questions about “unnecessary” surgeries such as hysterectomy,  knee surgery, or back surgery. Occasionally these are clearly indicated, but often the indications are ambiguous, as are the results. One wonders how much insurance reimbursement drives the choices. Furthermore, research has sometimes shown that sham treatments or physical therapy work just as well.

I responded that some of those conditions may be so problematic and severe that I would hesitate to declare them non-medical. But she had a point: There is another category she opened up, I conceded: Might there be such a thing as the semi-“cosmetic” or “-prosthetic” use of drugs to improve performance in school. Well, it’s ambigous. Are spectacles (glassses or contact lens) an analogy in the realm of vision? I don’t think we should say that nearsightedness and the use of glasses a medicalized process. I suspect that I am politically "for" the use of pills as much as glasses, or anything that serves to enhance life and reduce disability. That is to say, I do think for example that some meds for ADHD are really more prosthetic, like wearing glasses.

So "medicalization" is an interesting question from many viewpoints: Should society consider various procedures "elective" so that “our” insurance premiums collectively pay for them? Should we include procedures associated with medicine such as breast augmentation surgery? At what point in the spectrum of severity do we say that a person "really needs" this medicine or procedure? The fact that something is pervasive does not mean that there is no justification to ameliorate the problem. The older we get the more that applies to a wider variety of problems, too. I don’t claim to have ready answers. Sometimes it helps to just ask the questions.

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