There is no shortage of critiques of medical ‘reductionism’. ‘Reductionism’, in this context, is the claim that problems that have complex non-medical dimensions (be they social, psychological, economic, political and/or theological) are viewed as solely the purview of medicine. The result is a misunderstanding of the problem and a ‘solution’ that can make it worse. This phenomenon has been identified and criticized since the rise of medical authority, leading to a number of ‘holistic’ movements designed to counteract it. And yet, though it might seem that everyone is a ‘holist’, reductionism somehow endures. This seeming paradox is the topic of the collection To Fix or to Heal: Patient Care, Public Health, and the Limits of Biomedicine. Edited by Joseph E. Davis and Ana Marta González, the collection aims to explain the enduring power of reductionism, to document its effects and to propose a viable alternative. It argues that reductionism endures both because of the legitimate power of medicine and because of factors that are not ‘medical’ themselves. The negative ethical and medical costs of reductionism make opposing it a moral obligation. But such opposition cannot be zero-sum. It is a question of finding—and enforcing—the proper limits on medicine. The possibility of finding such limits within an edited volume might seem dubious. But the editors have done fantastic work selecting a group of contributors whose distinct disciplinary—and, to a degree, ideological—orientations are significant enough to make each essay unique and interesting. The chapters can stand alone, and are generally written at a level of difficulty appropriate to an upper-level undergraduate class or graduate seminar. But they read very well together, in large part because of the work of Davis, who contributed introductory and concluding essays that give the volume an overarching argument that unites its content across three different sections. The first section, ‘Reductionist Medicine in Cultural Context’, explores why reductionist medicine has successfully attained such enduring authority. The section opens with (another) fascinating essay by Davis that attributes the cultural authority of reductionist medicine to the union of seventeenth-century natural philosophy with the medical and scientific advances of the nineteenth century. Christina Simko’s contribution examines how depression memoirs rely on—and find some solace in—the amoral language of medical diagnosis. Luis Echarte argues that the rise of psychopharmaceutical enhancement is due less to medical progress than social factors underpinning medical reductionism. And Robert Dingwall examines how reductionist medicine was aided by—and furthered—the increasing conceptualisation of the patient as ‘consumer.’ The second section, ‘Reductionist Medicine and the Disease Burden’ argues that reductionist medicine is a poor response to ongoing changes in the burden of disease and disorder. Anne Hardy’s chapter examines how the ‘therapeutic revolution’ worked against both disease prevention and to the needs of the chronically ill. Deborah Lupton argues that individualized strategies of digitised health promotion entrench existing socioeconomic disadvantage, while making the poor feel responsible for health problems that are largely environmental. Jon Arrizabalaga’s helpful essay shows how confidence in reductionism has ironically (and tragically) led to the (re)emergence of fatal diseases. And Bruce K. Alexander shows how the dominant neurological paradigm of addiction maintains and even exacerbates the social dislocation that is, he claims, addiction’s dominant cause. The third section examines the need for a more holistic conception of medical ethics. John H. Evans argues that bioethical principlism, in its current form, extends medicine into new areas of life in a manner that undemocratically overrules a significant portion of US citizens. Jeffrey P. Bishop (my colleague at St Louis University) argues that attempts to ‘humanise’ medicine, whether coming from the humanities, social sciences, or bioethics, have in fact strengthened and extended its dominion. And co-editor Ana Marta González closes the section with a critique of attempts to reduce ethical questions to medical ones. In his concluding essay, Davis draws on the collection’s contributions to suggest various ways to limit the expansion of medicine. Critique must play a central role in this project, but so too should a reaffirmation of the ‘goods inherent to medical practice’ as well as alternative goods existing in diverse communities and institutions (p. 311). This is not just an intellectual project, but also a political one, as it involves mobilising professionals in medicine, bioethics and public health. One can disagree with Davis’ suggestions for each of these fields, but his attempt to engage the interests and strengths of distinct professional groups is admirable. The result is not so much a ‘conclusion’, as a newer, more dynamic starting point. But, as Davis himself notes, rejecting facile conclusions is part of the work that must be done. © The Author 2017. Published by Oxford University Press on behalf of the Society for the Social History of Medicine.
Social History of Medicine – Oxford University Press
Published: Feb 1, 2018
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