The second major critique of the biomedical model is less about the model itself, and more about the arrogance and hubris that it engenders in its followers.
Since the 1950s, dozens of writers have taken biomedicine to task for its hegemonic power (meaning its ‘preponderant influence or authority over others’ ) and control over the way we think about health and illness. People like Elliot Freidson, Terry Johnson, Magali Sarfatti Larson, Anne Witz, Ivan Illich, Mike Saks, and Anthony Giddens have offered scathing critiques of the biomedical model.
The biomedical model, they argue, attempts to penetrate too deeply into people’s lives, leaving little room for other ways of understanding health and illness.
No one doubts the achievements of the biomedical approach to health, but what is often forgotten is that this has been achieved on the back of phenomenal resource investment. The biomedical model is one of the best funded ideologies since the church, and has been massively indulged. So it is perhaps not surprising that it has made some discoveries and helped some people. But notwithstanding all of that, it’s perhaps not surprisingly that biomedicine sometimes resembles the only boy child of very rich parents – single-minded, sheltered from the real world, and highly privileged.
The advocates of the biomedical model have been historically blind to the fact that health is socially constructed. Even biomedicine is socially constructed. Which is ironic really, when you consider that biomedicine has no place for the idea of socially constructed health.
Regardless of biomedicine’s claims to objective truth, it isn’t itself a real thing like a pen or a car: it’s an idea, invented and sustained in the minds of people every day. It is fragile and takes an enormous amount of effort to perpetuate. And it has done so with a totalising interest in its own self-promotion.
Every assessment you do, every treatment you offer, every clinic room you enter, every colleague you speak to, every word you use to describe a health problem, is polluted with biomedical ways of thinking.
And because the biomedical model is so abstract, it requires an enormous system to support it, and the history of healthcare in the West for the last century or more is the outworking of that system.
To their discredit, advocates of biomedicine focus an enormous amount of energy on marginalising those ways of thinking that don’t conform to its ideology. Anything that is subjective, holistic, non-reductive, cultural, qualitative, experiential, spiritual, political, or non-biological is treated with skepticism or blank disregard. Biomedicine perpetuates the narrowest world view.
Since the 1960s, health activists, academics and theorists have offered persistent critiques of the limits of biomedicine. From disability activists, to feminists, post-colonial scholars to queer theorists, a plethora of critiques now exist to challenge the hegemony of the biomedical model.
But interestingly, few physiotherapists read this material or get exposed to it. This is because physiotherapy has been so colonised by the biomedical model that few people within the profession believe that other ways of thinking about health and illness exist, or carry any real currency.
But in the real world, people don’t think about their health biomedically, and perhaps one of the most important weaknesses of the biomedical way of thinking about health is that it cannot explain why everyone doesn’t follow it. There is an ironic paradox here then: the biomedical model is so narrow that it does not even include within it the means to critique how and why people don’t universally believe it.
The model does not explain the real world. If it did, it would reside in the real world and one wouldn’t have to study to become a trained health professional to understand and apply it. Biomedicine then, at its worst, sits at odds with the people it is meant to serve; looking, again, rather like a spoilt (white, male), only child of very rich parents, in a room full of people whose lives are very different indeed.
In the next post we’ll dig into some of the more specific ways that health can be thought of differently, and the way these reveal some of the limits of the biomedical model.