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Sanism and the Psychologisation of Physical Illness

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People with myalgic encephalomyelitis (ME) usually react negatively to the suggestion that our illness is psychosomatic. Psychologisers often retort that our reaction originates in and reveals negative attitudes towards mental illness. Before examining this rhetorical device, we need to be clear on why people with ME actually resist the psychologisation of our illness. As I explained in a previous blog post , state and medical institutions together with insurance companies have controversialised ME: they have buried the unequivocal evidence that ME is a physical illness in an effort to avoid funding research into treatments, medical care, and social support for the millions of people disabled by ME. Their main strategy has been to fund, reward, and amplify the fraudulent research of a handful of psychiatrists arguing that ME is nothing but “false illness beliefs” held as a result of social influence in order to reap the supposed benefits of the “sick role”. The resulting widespread na
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Capital and the Controversialisation of Illness

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Myalgic encephalomyelitis (ME) is often called a contested disease. Although the suffering of people with ME is usually not called into question, at least not explicitly, questions are raised about whether this suffering is best apprehended through a medical lens. Medical professionals in particular often contest claims to the effect that the illness requires biomedical treatment. They regularly assert that no scientific evidence exists to support the claim that it has an organic basis, such that the symptoms are “medically unexplained”. Together with a handful of other illness, it is therefore termed a “disease of unknown aetiology” or “persistent somatic symptoms”. This suggests that their contestation of our disease is of a purely scientific, apolitical kind: it is simply what the evidence indicates. But for more than forty years, study after study has documented immunological, metabolic, neurological, and vascular aberrations in ME, such that the evidence for an organic basis to t
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Doctor’s Knowledge, Patient’s Knowledge

In the dominant collective imaginary, there is a sharp asymmetry between what a patient knows and what a doctor knows. The patient knows their own bodily experience. They know, in the terminology used to describe such situations, what their symptoms are. The doctor has all the rest of the knowledge: of the significance of these symptoms, and ultimately after tests only they know when to order and how to interpret, of the cause of the symptoms (usually referred to as “diagnosis”), the course the illness is likely to take (the “prognosis”) and the most appropriate treatment plan. We have, therefore, a highly asymmetrical situation where the patient and the doctor know strictly different things: just like the patient doesn’t have the knowledge required to accurately identify a cause, course, or treatment for their symptoms, the doctor doesn’t have independent knowledge of what the symptoms and, more broadly, lived experienced of the disease are. This conception of the knowledge dynamics a
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Debates on the Nature of Disease

One of the central debates in the field of philosophy of medicine concerns the nature of disease. There are many different positions with interesting and subtle differences, but they are usually divided into two types: naturalist views which separate disease from health on the basis of purely natural, biological facts , and normativist views, which distinguish disease from health at least partly by appeal to value , of what is good and what is bad for the person involved.  The paradigm naturalist view is that of Christopher Boorse (1977). According to him, what makes a body diseased is that it is not functioning properly, as compared against bodies of the same age and sex. So, for instance, a person with tuberculosis is diseased, in virtue of the fact that their lungs are no longer able to perform their proper function, as measured by, for instance, reduced oxygen extraction compared to the average person.  And the most prominent normativist view is that of Rachel
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Welcome!

In a former life, I taught and researched philosophy at university. I was working on many things, among which the philosophy of illness, disability, and medicine. I was in the early stages of writing a book, which I’d tentatively titled Epistemology of the Clinic . In September 2022, a covid infection disabled me. I acquired many new illnesses under the umbrella term of “long Covid”, by far the most disabling of which is myalgic encephalomyelitis (ME, also sometimes ME/CFS). I have a severe form of ME: I was almost completely bedbound until April 2023, when a reinfection or a bad reaction to a medication left me entirely bedbound: my feet have not touched the floor at all since. I am very sick, and forced to spend the vast majority of my days lying in complete silence and darkness, and to endure quite a horrific level of suffering. The rest of the time, I can use my phone a bit, and sometimes have very short (but precious) conversations with my best friend and carer Camilla. I have bee
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