The ‘slow violence’ of Human Eco-Biological destruction by anticipatory medicine and a strategy of selective non-violent resistance.
Adapting Nixon’s (Robert Nixon: 2011 Slow violence and the environmentalism of the poor. Cambridge. Harvard University Press) concept of slow violence through environmental damage: we need new terminology to capture the idea of a human biological environment – a human ecobiological environment – the idea or concept of a person’s biological ecosystem: not as something perfectly capable of sustaining function, but something vulnerable to harm through medical intervention – an ecobiology crucial to individual and collective potential, vicariously, to function as well as possible.
Overtreatment; medicalisation and overdiagnosis:these are the humanly suffered forms of invisible slow violence equivalent to environmental damage : these form of slow violence are slowly dissipating through time, space and human bodies and slowly having effects on collective health through, for example, increasing overdiagnosis due to anticipatory technologies: unsolicited yet still applied or apparently just ‘offered’ to the asymptomatic population – this is causing a slow and insidious expansion of the screening diagnostic tools for screening and names, like pre-diabetes, applied to the de-individualised body/mind: just as technologies, such as de-forestation, intensive farming methods and fracking are applied to the earth’s crust. Yes, gas can be produced by cracking open the crust, but at what collateral environmental cost? Yes, screening can prevent cancer, but at what human eco-biological cost? Overdiagnosis, Overtreatment and medicalisation are invisible, because nobody ever knows they’ve been overdiagnosed because the treatments eradicate the future you might have had. And so the ‘problem’ of overdiagnosis does not capture the public imagination. Invisible because people do not want to know they may have been overdiagnosis because, then, all the anxiety, pain, ill health, and relationship problems caused by the intervention, shall have been as if for nothing.
A lot of health scientist and medical concern about overdiagnosis is by those who seem either to want to improve the science, or to improve the methods of communication about risk – both of which in fact only, and perversely, serve to reinforce the ideologies that: a) ‘innovative science is good’: thereby expanding technology using empirical science and b) ‘transparency and eliciting values leads to democratic decision-making’, thereby de-individualising the individual in the name of humanising the patient and ‘eliciting her values’ – as if the market and its offer to apply better objective science to diagnose ‘your’ cancer early, has no impact on personal values. And yet our values are constituted through and amongst a) our existential struggles for identity, b) with fear/desire/guilt and with c) the apparent moral imperative to consume.
Healthcare may have something useful to learn from the politics of non-violence (see Gene Sharpe 1973, The politics of non-violent action, referenced in Glaser 2019. Jeffers’s axe: the instability of non-violence. Psychoanalysis, Culture and Society. Vol. 24. 1. 1-14). Whilst a comprehensive ethical stance that aims to never do harm (violence) is impossible for care providers since most treatment of illness or suffering carry a risk of harm. Yet, a strategic policy of selective non-violence may be effective (as it has been politically in other arenas such as combating colonialist oppression in India) with a particular goal in mind, such as reducing overdiagnosis.
One could have a policy of selective non-violence by targeting a particular form of healthcare oppression. I am thinking here of a form of oppression that is a) anti-democratic because it uses rhetorical slights of hand that demand consumption and relies on both the incitement of people’s irrational fears of ill-health as well as desire for commodities that promise to, but often fail to, provide the security of surplus life; b) causes harm: overdiagnosis, that is never valued adequate to the harm it causes and is invisible because no one ever knows they’ve been overdiagnosed, or, therefore, experiences it as such, and c) reduces both the opportunity and human potential for delivering care-with-love, or kindness, to individuals who are suffering. This form of oppression is due to a particular cause of slow violence through collective and personal human eco-biological destruction: namely, unsolicited population-based anticipatory diagnostic medical nominal expansion and screening.
A strategy for selective non-violence to resist and reduce overdiagnosis of the asymptomatic would be for care-providers. to refuse to offer this care to, or even counsel against this form of care for, the public. And, for care-consumers and labourers to campaign against, sanction, this form of care
The end of capitalism is tricky / it feeds off its own disasters : because mystical intuitive pragmatism shrieks and finds another commodity to fix it.