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

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

Response to Open Peer Commentaries on "Diagnosis By Television Documentary: Professional Responsibilities in Informal Encounters".

In presenting the situation of a health professional witnessing an instance of misdiagnosis and mistreatment in a television documentary, we hoped to stimulate discussion of the professional responsibilities of health workers in informal encounters in a rapidly changing environment comprising print, television, and more recently social media platforms. The commentaries on our article do not disappoint in this respect, providing insightful and sometimes challenging reactions to the position we outlined in response to our original case. In our reply here, we choose to focus on two themes running through all of the commentaries: (1) the distinction between axiological and deontic perspectives invoked by Salloch, and the open-endedness of the former that we see as crucial in addressing the constantly changing media landscape through which health workers may confront medical need; and (2) the role of institutional, structural, and social factors in constraining or enabling virtuous professional practice—suggesting perhaps a further need for health workers to take action directly against structural injustices that prevent them from fulfilling their professional responsibilities

Diagnosis by Documentary: Professional Responsibilities in Informal Encounters

Most work addressing clinical workers' professional responsibilities concerns the norms of conduct within established professional-patient relationships, but such responsibilities may extend beyond the clinical context. We explore health workers' professional responsibilities in such "informal" encounters through the example of a doctor witnessing the misdiagnosis and mistreatment of a serious long-term condition in a television documentary, arguing that neither internalist approaches to professional responsibility (such as virtue ethics or care ethics) nor externalist ones (such as the "social contract" model) provide sufficiently clear guidance in such situations. We propose that a mix of both approaches, emphasizing the noncomplacency and practical wisdom of virtue ethics, but grounding the normative authority of virtue in an external source, is able to engage with the health worker's responsibilities in such situations to the individual, the health care system, and the population at large

'I just need to know what they are and if you can help me': Medicalization and the search for legitimacy in people diagnosed with non-epileptic attack disorder

This paper focuses on the struggles for legitimacy expressed by people with non-epileptic attack disorder (NEAD), one of the most common manifestations of functional neurological disorder presenting to emergency and secondary care services. Nonepileptic attacks are episodes of altered experience, awareness, and reduced self-control that superficially resemble epileptic seizures or other paroxysmal disorders but are not associated with physiological abnormalities sufficient to explain the semiological features. "Organic" or medicalized explanations are frequently sought by patients as the only legitimate explanation for symptoms, and consequently, a diagnosis of NEAD is often contested. Drawing on narrative interviews with patients from a small exploratory study and using a sociological perspective, we propose that a psychological account of NEAD does not provide a sufficiently legitimate path into a socially sanctioned sick role. This is a reflection of the dominance of biomedicine and the associated processes of medicalization. These processes are, we argue, the sole route to achieving legitimacy. The stress-based or psychologically oriented explanations offered to patients in contemporary medical models of the etiology of NEAD engender an uncertain identity and social position and fail to provide many patients with an account of the nature or origin of their symptoms that they find satisfactory or convincing. These struggles for legitimacy (shared by others with functional or somatoform conditions) are sharpened by key features of the contemporary healthcare landscape, such as the increasing framing of health through a lens of 'responsibilization'. [Abstract copyright: Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.

Mistaking the Map for the Territory: What Society Does With Medicine Comment on "Medicalisation and Overdiagnosis: What Society Does to Medicine" Commentary

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

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

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

Climate change: attitudes and concerns of, and learnings from, people with neurological conditions, carers and healthcare professionals

OBJECTIVE: Concern about climate change amongst the general public is acknowledged by surveys. The healthcare sector must play its part in reducing greenhouse gas emissions and adapting to a changing climate, which will require the support of its stakeholders including those with epilepsy who may be especially vulnerable. It is important to understand this community's attitudes and concerns about climate change and societal responses. METHODS: A survey was made available to over 100,000 people amongst a section of the neurological community (patients, carers and clinicians), focussed on epilepsy. We applied quantitative analysis of Likert-scale responses supported by qualitative analyses of free-text questions with quantitative-dominant crossover analyses, used to identify consonance and dissonance between the two approaches. RESULTS: A small proportion of potential respondents completed the survey: of 126 respondents, 52 had epilepsy and 56 explicitly declared no illness. The survey indicated concern about the impact of climate change on health within this neurological community focussed on epilepsy. Over half of respondents considered climate change to have been bad for their health, rising to 68% in a sub-group with a neurological condition, and to over 80% expressing concern for the future. Most (>75%) believed that action to reduce greenhouse gas emissions will lead to improved health and wellbeing. The crossover analysis identified cost and accessibility as significant barriers. SIGNIFICANCE: The high level of concern about climate change impacts and positive attitudes towards policies to reduce greenhouse gas emissions, provide support for climate action from the epilepsy community. However, if policies are implemented without considering the needs of patients, they risk being exclusionary, worsening inequalities, and further threatening neurological health and wellbeing