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Medicalization and the Medical Model

Medicalization, is defined by Cathrine Kohler Riessman as:

The term medicalization refers to two interrelated processes. First, certain behaviours or conditions are given medical meaning – that is, defined in terms of health and illness. Second, medical practice becomes a vehicle for eliminating or controlling problematic experiences that are defined as deviant, for the purpose of securing adherence to social norms. Medicalization can occur on various levels: conceptually, when a medical vocabulary is used to define a problem; institutionally, when physicians legitimate a programme or a problem; or on the level of doctor-patient interaction, when actual diagnosis of a problem occurs.

In the disability context it means that our identities are medicalized everything that we are or will be is seen through the medical scope. Under the medical model or approach to disability, we become our disabilities and our disabilities are seen only as negative or bad because that is how the medical profession sees them.

This plays out in a lot of different ways in our daily lives. Some of them are:

Biased, Discriminatory Medical Care: Our entire medical treatment is filtered through our diagnoses. This is problematic because doctors often attribute all of our symptoms to our disability and do not necessarily investigate fully or properly. This means someone could go into the doctor complaining of a serious problem and essentially be patted on their head and sent off because this is a symptom or progression of their disability when it could be something else entirely. This means that when many disabled people seek out medical care they do not get as thorough treatment as non-disabled people. This is especially the case when it comes to psychiatrized people and psych survivors as their physical symptoms may be disregarded and attributed to ‘psychosis’ when they require treatment.

Similarly, when a fat person goes to the doctor with knee pain, the doctor will likely tell the person to lose weight. But if a thin person goes to the same doctor with knee pain, they doctor will likely examine them and do tests. Both people could have the same condition and the same amount of pain but because fat people are medicalized, they are not treated with respect and their complaints are not investigates.

Perception of Low Quality of Life: As disabilities are defined solely as bad by medicine, our disabilities are counted only as negatives in our lives – which isn’t the case for many disabled people. Further, it has been found that doctors routinely value our quality of life lower than disabled people do. The most dramatic illustration of this is when disabled people try to seek medical treatment and are denied it because doctors view them as being ‘better off dead’. There was at least one case where a disabled person had to fight to get life saving treatment because the doctors felt that they would be doing him a disservice if he continued to live.

We Are Defined as Dependent Patients: Disabled people are not seen as agents of their bodies, rather as patients who have things done to them and who are dependent on doctors to cure or treat us. This is not what disabled people’s lives are actually like.

The reality is that whatever medical diagnoses a disabled person may or may not have tells you nothing about who they are. It is a common pet-peeve among many visibility disabled people that non-disabled people are constantly asking “what do you have” or “what is wrong with you” (the second being a slightly more offensive version of the first). If you ask someone what they “have” and they tell you that they have CP, spinal muscular atrophy, fibromialgia, schizophrenia or lupus, what does that tell you about what they think about the world? What does it tell you about what kind of music they like or what they do with their free time? What does it tell you about who they are in love with or what they hope for the future? It tells you nothing about who they are.

Disability Is Individualized: the medical model of disability individualizes disability, paints it as an individual tragedy, and does not account for social barriers. Western medicine positions disability between the doctor and the patient (disabled person) where the patient has the disability and the doctor has the tools to ‘cure’ the patient. Where the doctor is unable to ‘cure’ the patient, the doctor then treats the disability. If treatment is unsuccessful (in the doctor’s view of success) the doctor then fills out forms to allow the patient to seek income support if the patient is physically or mentally unable to find and keep employment.

Doctors Have Power Over Our Daily Lives: Doctors are asked to provide medical information that is translated into non-medical resources (such as housing, food and transportation). As doctors are not necessarily skilled in the delivery of these services, they can misrepresent the needs of disabled people. Doctors are often lacking a true understanding of poverty because they are rich and they may not work to ensure their patients get access to the resources they deserve because they do not understand what many disabled people need and how badly they need it. Just one example of this is that some doctors refuse to fill out any forms for people on social assistance even if they are paid to do it and even if their patients could get hundreds of dollars a month extra to live off of.

Click here for more on ‘The Cure’.

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Ford, Fatness and Disablism

While this post predates the crack scandal, I want to encourage people to read it and also to think about how crack is being used in the same way that fatness was previously. While people are scandalized by Ford’s crack use, no one cares about his racism and homophobia that also came out in the video (although, arguably these aren’t news because we all knew this about him). Crack users are often made out to be convenient scapegoats and the Left is using some really troubling tactics when they go after Ford for his drug use much in the same way it did his weight. Again, Ford is an oppressive, rich, asshole who has to go but those things are independent of his being fat and a crack smoker.

I have been incredibly frustrated for a while about the trite, lazy attacks on Rob Ford because he is fat. There are so many good reasons to attack Rob Ford: his austerity measures, his fucked up neo-liberal ideology, his attacks on marginalized communities (p.s. this does not include cyclists), his jerk of a brother, his love of the rich and hatred of the poor, his despicable calls to make Toronto refugee free, his love of cops, his anti-unionism or his overall threat to the few good things that we have in this city (parks, libraries, daycare, graffiti, public housing, youth programs and lunch programs, etc.); rather, I am writing it about his body. That people focus on his body really pisses me off.

A recent Huffington Post article “Why Rob Ford’s Weight Is a Political Issue” by Ben Johnson argues that Ford’s size is relevant to critiques of his politics. In this post, I argue that this position is sizist, disablist and dangerous.

Fatness is a disability
Fatness is medicalized and fat people experience oppression based on the fact that their bodies do not meet normative cultural standards. Like most disabilities, fatness has not always been a disability but it is now. (There are many resources that deal specifically with sizism [see Big Fat Blog] but for the purposes of this article, I will discuss the issue of fatness and sizism within the broader context of disablism).

Blame and Shame
Johnson says that “it would be impossible not to assign Ford at least some of the blame for getting that big.” There is a presumption that fatness is self induced and, therefore, both the individual’s “fault” as well as a justification for the oppression of fat people.

It is not fat people’s ‘fault’ they are fat. This is an individualizing perspective that negates both the fact that fatness is a social construct as are the barriers fat people face. What is considered fat is arbitrary and shifts with cultural norms. A few hundred years ago, fatness was considered the ideal. This ideal did not shift with shifting medical information; rather, it shifted with social pressures.

There is nothing shameful about being fat – about being disabled. What is shameful is a society that judges certain kinds of bodies because they do not meet arbitrary and oppressive standards of desirability and productivity.

Even if blame could be assigned to individuals, it is irrelevant to their social positioning once they are disabled. Say you are driving too fast, flip your car and get a spinal chord injury. This was a predictable possible outcome. So, now you are a paraplegic. Are you less disabled because the accident was your fault?

The Slippery Slope
Questioning someone’s ability to make decisions, hold political office and have personal restraint because that person is fat is disablism.

The argument that Ford is unfit to govern because he is at risk for a number of health conditions is a dangerous one. It endangers not only disabled people but many other groups of people. Johnson says that Health Canada names obesity as a leading cause of heart disease and stroke. Health Canada also lists age as a leading cause of heart disease and stroke. So, by Johnson’s argument, we should really make sure not to have men over 45 or women who are postmenopausal or over 55 be mayor. It is just too risky to have them in office.

Family history is also a primary cause for heart disease and stroke. Imagine what it would mean to implement a system of genetic screening into the determination of mayor. This argument has eugenic implications.

There have been others who argue that women can’t lead because PMS makes them too emotional (and post menopausal women are already out because of that heart disease and stroke thing). So, women shouldn’t be able to take office.

These kinds of arguments open the door to argue that any group of marginalized people can’t take office because they are inferior.

Disabled people should be an integrated and integral part of the fight against Ford. In many ways we are active in the fight (through groups like DAMN and OCAP), but in other ways many disabled people, especially fat people, feel demeaned and alienated by these petty, disablist discourses. Please, we have so many strong arguments against this guy, let’s use them.

There are a whole lot of reasons Ford shouldn’t be in office; his fatness isn’t one of them.

In-text links used in this post:

“Why Rob Ford’s Weight Is a Political Issue”

Big Fat Blog

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Immigration Victory – But the Battle Continues

The Maeng family is going to be able to stay in Canada. This is great news for them and their community. For their story, click here. While there are success stories, from time to time, about disabled people being able to stay in Canada despite immigration policies. In these instances, like with the Maengs, the government makes an exception to the rule that disabled people aren’t allowed to immigrate if they are going to be a ‘burden’ on the health system. This is a disgusting policy. It is also disgusting that disabled people have to get media attention and public support in order to overcome this disablist policy.

Of course, there are many problematic policies in the immigration system: it is racist, sexist, classist and disablist and all of these need to be fought.