{"id":1343,"date":"2018-06-17T18:50:45","date_gmt":"2018-06-18T01:50:45","guid":{"rendered":"http:\/\/blog.stevenreidbordmd.com\/?p=1343"},"modified":"2018-06-18T08:39:41","modified_gmt":"2018-06-18T15:39:41","slug":"what-counts-as-a-medical-issue","status":"publish","type":"post","link":"http:\/\/blog.stevenreidbordmd.com\/?p=1343","title":{"rendered":"What counts as a medical issue?"},"content":{"rendered":"

\"\"<\/a>It has become a sign of legitimacy to call a personal problem “medical.” \u00a0This aims to distinguish the problem from those of morality or character. \u00a0It implies both that the problem is serious, and that it is unbidden and largely out of the suffer’s control. \u00a0Unfortunately, it isn’t clear what exactly qualifies as “medical,” so this label serves more as a rhetorical device than a scientific finding.<\/p>\n

Alcoholism<\/a> is the paradigm and perhaps least controversial example. \u00a0Through the 19th Century, alcoholism was variously declared a disease, or a matter of will and character. \u00a0The disease model gained prominence in the 1930s and 40s with the “powerlessness” identified in the 12 Steps of Alcoholics Anonymous, as well as\u00a0researcher E.M. Jellinek’s descriptions of progressive stages and subtypes of alcoholism. \u00a0The American Medical Association\u00a0declared alcoholism an illness in 1956 and has endorsed the disease model ever since, partly as a strategy to ensure insurance reimbursement for treatment.<\/p>\n

The model\u00a0expanded<\/a> to include other abused substances with the formation of Narcotics Anonymous in the 1950s, and as a result of widespread recreational drug use in the late 1960s and early 1970s. \u00a0The specialty of addiction medicine was first established in 1973 in California. \u00a0The American Society of Addiction Medicine now\u00a0states<\/a>: “Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” \u00a0Proponents of the disease model of addiction<\/a> cite many documented brain changes and a plausible neuropathology, as well as the presence of genetic risk factors, cognitive and emotional changes, impaired executive functioning, and disability and premature death. \u00a0The model purportedly destigmatizes addicts \u2014 they are no longer \u201cbad\u201d or \u201cweak\u201d people \u2014 thereby making it more acceptable for them to seek treatment.<\/p>\n

Nonetheless, the disease model of addiction remains controversial. \u00a0In addition to the existence of<\/a>\u00a0alternative<\/a> models<\/a>, the disease model itself has been criticized. \u00a0Some believe it\u00a0removes<\/a> personal choice and responsibility, and actually contributes to the problem of addiction. \u00a0Others cite surveys<\/a> of American physicians who consider alcoholism more a social or psychological problem \u2014 even a “human weakness<\/a>” \u2014 than a disease. \u00a0Critics note that about 75% of those\u00a0who recover from alcohol dependence do so without<\/a> seeking any kind of help, and that the most popular and recommended treatment, Alcoholics Anonymous, is a fellowship and spiritual path, not a medical treatment.<\/p>\n

Behavioral addictions to\u00a0gambling<\/a>, sex<\/a>,\u00a0pornography<\/a>, the internet<\/a>, video games<\/a>, and\u00a0food<\/a> are described in language that explicitly parallels addiction to alcohol and drugs. \u00a0The same brain pathways are implicated.\u00a0 Accordingly, these problems are called medical as well.<\/p>\n

Addiction is not the only domain that has been declared, often somewhat stridently, as medical. \u00a0\u00a0Depression<\/a> has been deemed a medical issue for several decades now, using much the same rationale. \u00a0The push to frame all psychiatry as neurobiology<\/a> is a larger matter. \u00a0But here, too, documented brain changes, genetics, and characteristic signs and symptoms underlie a rhetoric that may, or may not, decrease stigma and facilitate treatment. \u00a0Moreover, a number of other behaviors and traits, formerly considered bad habits or personality quirks, are now reified as discrete psychiatric disorders (not the same as diseases, but close): shyness is now social anxiety disorder<\/a>, misbehaving kids have oppositional defiant disorder<\/a>, and so forth. \u00a0What are the risks in subsuming more and more of human experience into nosological categories?<\/p>\n

One risk is that medicalizing problems may hide political or other bias. \u00a0The most shocking historical examples include\u00a0drapetomania<\/a> in the U.S. and the\u00a0misuse of psychiatry<\/a> in the former Soviet Union. \u00a0Yet even well-meaning efforts to highlight a social problem, give it gravitas, and impart a clinical, impersonal air to one’s opinions can result in this sort of over-reach. \u00a0Examples include the “politics is part of pediatrics<\/a>” antiwar stance of famed physician-author Benjamin Spock, and Physicians for Social Responsibility<\/a>, a group that opposes nuclear arms from a medical perspective. \u00a0Most recently, some mental health professionals have published impassioned<\/a>\u00a0statements<\/a> characterizing President Trump’s behavior in\u00a0medical\/psychiatric terms. \u00a0Such statements have no medical purpose: they\u00a0neither clarify Mr. Trump’s behavior (which is well known to all), nor change it. \u00a0Their effect, if any, is solely on electoral politics. \u00a0Medical language can thus amount to little more than grandstanding.<\/p>\n

A related risk of medicalization is that it may lurch toward absurdity. \u00a0Suicide, that profoundly personal matter studied by poets and philosophers as well as scientists, also may be deemed a disease<\/a>. \u00a0This confuses disease with symptom \u2014 as if “headache disease,” for example, were touted as a new diagnostic entity. \u00a0No doubt there will soon be measurable brain findings that distinguish suicidal people from non-suicidal people; no doubt such findings, too, will soon distinguish the state of having a headache from the state of not having one. \u00a0In this nascent era of functional brain imaging, is it sufficient to see something “light up in the brain” to call it a medical problem?<\/p>\n

Doing mental arithmetic<\/a> is detectable by fMRI. \u00a0Is math a medical issue?<\/p>\n

A plainly medical disease such as diabetes results from nature and<\/em> nurture, genetics and environment. \u00a0What makes it medical are not its causes. \u00a0The effect of diabetes on the human body, the fact that it historically has been treated by physicians, and to a lesser degree the nature of its treatment make it medical. \u00a0Addiction also appears to result from genetics and environment, to have consistent effects on the human body, and for a few decades at least, has been treated by physicians. \u00a0Its treatment, though, is mostly non-medical in the usual sense of the term, i.e., not pharmacological or surgical. \u00a0There are strong behavioral and psychological aspects to addiction, and often sociocultural ones as well. \u00a0It is thus not surprising that its status as medical remains, to some, a matter of debate. \u00a0However, by the time we get to war, nuclear arms, a heretofore unimagined presidency, or suicide, we are talking about matters that have no consistent findings in the human body, are not historically treated by physicians, and respond almost exclusively to non-medical solutions. \u00a0The phrase “medical issue” can’t stretch to cover this territory, no matter how fervently physicians would like to weigh in.<\/p>\n

In the future, more and more brain function will be open to scrutiny. \u00a0As our brains mediate all human behavior, advancements in functional imaging and similar technology may tempt us to declare any and all products of the human mind “medical issues.” \u00a0Problems such as prejudice, racism, violence \u2014 or, from other viewpoints, liberalism, collectivism, and the like \u2014 may be claimed as the physician’s to treat. \u00a0It will be hard to resist this temptation; doctors like to fix things. \u00a0But the cost of succumbing is to reduce medicine to threadbare rhetoric, weakening our moral status as healers of the human body.<\/p>\n

Graphic courtesy of Pixabay, CC0 license.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

It has become a sign of legitimacy to call a personal problem “medical.” This aims to distinguish the problem from those of morality or character. It implies both that the problem is serious, and that it is unbidden and largely out of the suffer’s control. Unfortunately, it isn’t clear what exactly qualifies as “medical,” so […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[67,7],"tags":[52],"class_list":["post-1343","post","type-post","status-publish","format-standard","hentry","category-medical-practice","category-psychiatric-diagnosis","tag-neuroscience","odd"],"aioseo_notices":[],"_links":{"self":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts\/1343","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1343"}],"version-history":[{"count":8,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts\/1343\/revisions"}],"predecessor-version":[{"id":1352,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts\/1343\/revisions\/1352"}],"wp:attachment":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1343"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1343"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1343"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}