It is something called ‘jouissance’ that the Perverted psychical structure encounters – the sense of not being desired for your own sake but of being a chattel to be used for somebody’s pleasure, as an object. Unable to be desired must be traumatic, and must lead to an intense need, but a need based on a cruel objectification of the other, and a need to seek out a suitable victim for the pervert’s non-desiring but needy pleasure.

The jouissance of medicalisation has: 1) a political/cultural disenfranchised ‘excluded’ subject to be enjoyed, 2) a Medical Target within that disenfranchised population and 3) an ‘example’ of the structure of perversion that reveals the horror of the Medical Fantasy.

The cultural extension in the West under capitalism, called an ideology by some, comprises the special sub groups within the target population, and may include: the disenfranchised unemployed (already guilty of general fecklessness and incompetence, child abuse, domestic violence, crime, addiction, etc), perhaps religious ‘minorities’ (e.g.Muslim and Jews), women, and in particular, mothers. The target population for Medicine is universal, and is the ‘to be excluded feminine or feminised subject’, and is universal, i.e. all subjects. The examples that reveal the horror and fear of the JOUISSANCE occur when agents of the Medical Order go too far and act out the fantasy of The Establishment.

The perverse agent might, like Meadow and Southall (the ‘star’ expert paediatricians who falsely accused many mothers, in the late 1990s earl 2000s, of murdering their babies using a bloated diagnostic category they helped create: Munchausen Syndrome By Proxy) ,  do this because of a crisis in their own investiture(s) (perhaps as children ‘maternal’ or “oedipal’ and then later in life cultural or social) resulting in a libidinal structure of perversion (in a Lacanian sense) with their symbolic network, they act on the fantasy (of The Other in this case Medicine) and enable it to irrupt as The Real into the Symbolic. Their acts betray the fantasy of The Medical Order which is to medicalise all, to impose The Law as the injunction: “Be Normal!” upon all.

It is however difficult to ‘know’ the cause of a perverted psychical structure  – maybe it can’t be known. It may be the crisis is within the dominant Modern Medicine ideology, its disavowal of ‘not-knowing’ resulting in a constant misrecognition of e.g. test results, tissue representations (e.g. mammograms).

Particular perverse agents focus on particular ‘medical crimes’: the ‘murdering mother’, the ‘cancer-thief’ (who is guilty of having stolen the ‘enjoyment-JOUISSANCE’ of the possession of the cancerous body part that rightfully IS TO BE ENJOYED BY (hence the jouissance) the Primal Father The Medical Pervert e.g Halstead in the 1920s, or today, perhaps, Mr Paterson, and indeed the Logic of National Cancer Screening Programmes, with their emphasis on ‘early diagnosis’ first introduced, tellingly I think, by The Nazis in the 1930s.

See Judith Feher-Gurewich in Cambridge Companion to Lacan page 194:

Jouissance drives the pervert on. Not to own but to have the right to ‘enjoy’ provides the libidinal gratification provided by the process of seeking out the object, the target, the thief, as in an inquisition.  If jouissance does not employ ownership does this disrupt the Marxist analogy/exension of debt peonage already described (the notion that the system ensures debt can never be paid off but grows at the same rate as repayments are made)? if the ‘right’ is to enjoy something how is this different from owning it: you are no longer the object of desire as such, the punter does not desire The Woman, or even to own her, marry her etc, but just to enjoy her, to reify her, dehumanise her. When the subject sacrifices the Body Part, The Body Part is then ‘owned’ by The Medical Other and State, but the woman has been ‘enjoyed’ – has encountered the JOUISSANCE of The Medical Other.