In the latest addition of the BMJ Margaret McCartney (BMJ 2015;350:h439) asks if : “All knowledge is Power”, and she critiques the diagnostic uses of genomic industries such as ’23andme’. I think the converse is true and reveals a truth behind medicalisation.
“All Power is through the illusion of knowledge”
Medicalisation and the abuse of ‘diagnosis’ (using healthy people to create disease products for a capitalised Modern Medicine) is ensured by Medicine’s insistence upon ‘knowledge’ (and a consequent disavowal of ever not-knowing). This requires a ‘blindness’ to ‘not-knowing’ e.g. the inability to not-know or a blindness to the forbidden acknowledgement that the doctor simply does not know what a given test result means (the classic example is the borderline tissue representations in breast biopsy samples) – or even that a particular test might produce an uninterpretable tissue representation.
The ‘blindness’ to not knowing is the result of the way Power operates through the discourses through which individuals and the various Establishments (including Modern Medicine) communicate. To be a Medical Bureaucrat, a Doctor, Nurse, or Patient is to be a Subject-of-Medical-Science, living in a kind of dream world where to be Healthy is paradoxically forbidden. The Power operates because of our constant individual desire to a) find ‘love’ (to find the ultimate solution to the void within each of us) and b) in a magical way, have faith in a Big Other, who we imagine, guarantees that love. A faith that guarantees material behaviours that ensures our contribution to the continuation of the illusion and our blindness. How else can we explain why good people do such dangerous things?
How else can we explain what is likely to be a continued exponential growth in levels of medicalisation and the abuse of the diagnostic process on the healthy. What we can be sure of is that the continued appeal to rationality, transparency and science, eg more shared decision making and use of things like Subjective Expected Utility Analysis etc, will only perpetuate the particular problem of the medicalisation of the healthy, precisely because it perpetuates the illusory blindness to not knowing. If a test is likely to throw up an uninterpretable result and provoke a coerced medicalisation involving harms for sure and no known benefits, then why do it? The classic slogan that appeals to our libidinal desires is “Catch it Early” – its Power is in its Promise of All Knowledge. Medicine is making objects of the individual and treats the individual as if they are a thief, someone who has stolen Medicine’s enjoyment,stolen Medicine’s Sublime Object, an object that is always a mystery but manifests itself in the tissue representations brought forth by ever more deeply penetrating technologies.