Prevention is not the answer

Alchemical Musings has written a sharp (as a tooth and nail) account of some pretty troubling directions in biological psychiatry, which is moving toward the territory of prevention.

As he notes:

Instinctively, preventative health care seems like a good thing. Western medicine is often criticized for primarily responding to acute crises, instead of proactively promoting health and well-being. However, the reductionist flattening of minds into brains leads to categorical errors which pervert the Hippocratic principle to “do no harm”. Applying the medical paradigm of treating risks (instead of disorders) to mental conditions stretches the dangerously elastic diagnostic net beyond the breaking point.

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3 thoughts on “Prevention is not the answer

  1. “The trend towards prodromal mental diagnoses is frightening precisely because it cedes even more power to an already cold and inhumane apparatus, which fails to listen to the voices of the people it claims to treat. The risks of preemptive discipline and prescriptive moral judgment reek of eugenics, and are simply too great and horrifying for this practice to continue. ”

    Not that I’m obsessed with correct usage of particular words, of course I would never be that, but what is “eugenic” about the above? I can see how one might describe a trend towards prodromal diagnoses as slippery-slope-ish, as social engineering, as something out of Brave New World, as pathologizing, etc, but I just can’t see what’s eugenic about it. I think this is another instance of using the e-word as a sort of broad gloss for “things we should all be against”, rather like the way “liberal” or “socialist” get used in other discursive settings, with only a tangential connection to their actual meaning.

  2. Hi Manypetunias,

    Thanks for reading my post so closely. Strictly speaking, you are correct, and I have updated my post to read “rhymes with eugenics” instead of “reeks of”.

    For some background, I wrote this piece in the context of a disabilities studies class where we have been reading alot of material on pathalogies and the norm. Lenard Davis has made the argument that:

    “a symbiotic relationship exists between statistical science and eugenic concerns. Both bring into a society the concept of a norm particularly a normal body, and thus in effect create the concept of the disabled body.” (Davis, Constructing Normalcy, 1995)

    For sure, the mentally ill have long been targeted in the narrower sense of eugenics – identified as (genetically) inferior, and systemically discouraged from breeding.

    It is true that this short piece only alluded to those increasing possibilities, as hereditary and genetic markers continue to be sought (in vain). I guess I skipped a logical step, but what do you think is the natural progression of pathologizing genetic risk?

  3. Mrenoch,

    I clicked on your name and followed the links to several really interesting blog posts about this search for a medicatable prodrome. It sounds to me (and I may be stating the incredibly obvious here) like an effort to find or create a market for pharmaceuticals – if the existence of prodromes can be established, then the target population for anti-psychotics can be expanded (particularly if pharmas can justify repatenting their existing meds as preventives, as distinct from treatments, and thus benefit from restarting the patent-protection clock). From Furious Seasons’ posts, it sounds like the research on this is extraordinarily weak (e.g. very few of those identified with the prodrome ever developed schizophrenia, and there’s no statistically significant evidence that taking Zyprexa lessened the rate of onset, although it might have altered the time to onset slightly; and the side effects drove out many of the participants in the trials). I have a doctoral student who is planning to research the expansion of direct-to-consumer advertising of antipsychotics as new ways to treat mood disorders (and who has worked in the industry herself), and I’ll pass on all this quest-for-a-prodrome info to her. Thanks! Despite my quibbles with your word choice, I found this topic really interesting.

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