So far in this short series on the problems with the biomedical model we’ve looked at the mind-body separation, biomedicine’s claims to objectivity and access to the truth about health and illness, it’s construction of atomistic individuality, and last week, the problematic nature of normalisation. In this post we’ll look at the passivity that biomedicine engenders in patients.
Biomedicine is a powerful discourse and it has brought enormous power and social capital not only to the medical profession, but also to those who practice in its image. One of the most widely voiced critiques of medicine is that it is hegemonic (or dominant not through force but a degree of consent and subordination), and that this dominance has been used by all orthodox health professionals – including physiotherapists – to elevate their own social status, obtain higher pay, and professional autonomy.
Terry Johnson in the 1970s talked about how biomedicine was the main vehicle for doctors to create social distance between themselves and patients. This was achieved, Johnson argued, by building up vast bodies of complex knowledge inaccessible to the public, tightly controlling access to the market, and creating conditions of dependence on the profession (Johnson 1972).
A lot of medicine’s elite knowledge came to be targeted at differential diagnosis and the search for specific aetiology, which privileges the search for disorders that exist beyond the visible scope of the ordinary person. Only a few ‘elite’ members of society are given the social and economic resources (training, access to the necessary equipment and service staff, etc.) to access and interpret this information, and because only doctors claim to know the importance of this information, it is hard to deny requests for more resources and social support for their work.
Crucially, this knowledge refers to biological information ‘internal’ to the person that can be objectified and measures, as opposed to the social, cultural and biographic explanations for illness that cannot be seen on an MRI or measured in a full blood count. Hence the patient becomes the passive site for medical investigation, with the social and material causes of disease neglected in favour of the biological.
The enforced passivity of the patient that follows from this approach is inherently de-skilling though, and people can often feel that it is not them but the health professional that has insight and control over their bodies when they enter the healthcare system. This fosters a dependence on the heroic doctor or therapist. Self-care and the support of family can be discouraged, particularly if these interfere with established biomedical principles.
Medicine can inadvertently alienate us from our own bodies and make us distrust what we know and feel. Stories about not being believed by health professionals are the stuff of legend, while stories of being coerced into tests and treatments that don’t ‘feel right’ litter online patient support sites. Not surprisingly perhaps, complaints against health professionals that didn’t consult their patients before acting are commonplace across all orthodox health professions.
It is perhaps worth reflecting on the fact that we have to teach principles like informed consent to our students because we have a medical system that works from the basis that biomedicine is innately depersonalising. Informed consent is one of the ways we ‘manage’ this, but it can be just another vehicle delivered by health professionals to assure biomedicine of its dominance, and reinforce the patient’s position as passive and submissive.
Johnson, T. 1972. Professions and power. London: Macmillan.