Beyond medicalisation

N Rose - The Lancet, 2007 - thelancet.com
The Lancet, 2007thelancet.com
Medicalisation has become a cliché of critical social analysis. It implies something suspect
when a problem is created or annexed, in whole or in part, by the apparatus of medicine.
Critiques of the ways in which doctors have extended their empire have become part of
everyday and professional debate. Such critiques have contributed to the part
deprofessionalisation of medicine. Nowadays, the power of doctors is constrained by the
shadow of the law, the apparatus of bioethics, evidence-based medicine, and patients' …
Medicalisation has become a cliché of critical social analysis. It implies something suspect when a problem is created or annexed, in whole or in part, by the apparatus of medicine. Critiques of the ways in which doctors have extended their empire have become part of everyday and professional debate. Such critiques have contributed to the part deprofessionalisation of medicine. Nowadays, the power of doctors is constrained by the shadow of the law, the apparatus of bioethics, evidence-based medicine, and patients’ demands for autonomy to be respected, their rights to health satisfied, their injuries compensated. The focus of critique has turned to the methods used by drug companies in search of markets and profits. There is, no doubt, much to criticise. Yet medicalisation has had an even more profound effect on our forms of life: it has made us what we are.
Since at least the 18th century in developed countries, medicine played a constitutive part in “making up people”. 1 It was in part through medicine that the human being became a possible object for positive knowledge—a living individual whose body and mind could be understood by scientific reason. Medicine was perhaps the first scientific knowledge to become expertise, in which authority over human beings derived from claims to scientificity. Medicine was entwined with new ways of governing people, individually and collectively, in which medical experts in alliance with political authorities tried to manage ways of living to minimise disease and promote individual and collective health. Medicine was linked to the secularisation of ethical regimes, as individuals came to describe themselves in the languages of health and illness, question themselves against criteria of normality and pathology, take themselves and their mortal existence as circumscribing their values. The history of medicine has thus been bound up with the history of the different ways
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