The Bioethics of Diagnosis: A Biocultural Critique of Certainty

Abstract

This article argues that traditional models of diagnosis are incomplete in their reliance on a models of certainty that are no longer tenable in a postmodern world. Further, it argues that the current form of diagnosis, as applied to psychiatric and affective disorders, reduces patient agency and reinscribes the effects of biopower.

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Notes

  1. 1.

    Cultural and social factors are important in any diagnosis and within medical practice there are fads and trends in all areas. Recently I gave a version of this talk to fourth-year medical students at Albert Einstein College of Medicine in New York. One student pointed out to me that such factors impinged on something as simple as infantile digestion, with a huge increase recently in giving infants medication for reflux. The student maintained that about one-third of all babies now in the institution where she worked were on such medication.

  2. 2.

    I put the words “mentally ill” in scare quotes because there is a fundamental question, not answerable in this essay, about the ontological nature of psychic distress. Is it a disease, a condition, an philosophical problem, etc? The history of psychiatry leads us to an understanding of why mental conditions were considered “diseases” or “illnesses” but a large body of work and many new organizations now question the disease categorization.

  3. 3.

    Co-morbidity is a wriggle-room concept, like the cosmological constant that Einstein added to his general theory of relativity to try to keep a stationary model of the universe. Co-morbidity allows for a diagnosis in the presence of extraneous symptoms. Much more needs to be analyzed in this area, but the brevity of this essay won’t allow further discussion.

  4. 4.

    Robert Burton (2008) has written about the difficulty of arriving at certainty as a physician. He notes that “we aren’t reliable assessors” and that “an attempt to base our opinions on as thorough a scientific understanding as possible, while simultaneously reminding ourselves and our patients that our information will necessarily have been filtered through our own personal biases, affecting our selection of evidence and even which articles trigger a sense of correctness. Once we’ve made this admission, we have stepped off the pedestal of certainty and into the more realistic world of likelihoods and probabilities” (172–73).

  5. 5.

    Even the DSM’s recommendation that obsessive thinking might have a different kind of treatment from checking and ordering behaviors is a tacit admission that two different kinds of activities have been agglutinated into one disease entity.

  6. 6.

    One study indicated that diagnosis of mental disorders co-ordinated only very slightly with treatment outcomes.

  7. 7.

    In English one “has” a symptom. Why does one have it? Is it an object to have? More properly it might be said that the symptom has the person, transforming them into a patient by that having

  8. 8.

    While we might want to accept the idea that professional guidelines serve to insure that the patient is getting the best of the bioethical virtues from the practitioner, it is also the case that these guidelines that present a synthesis of bench science, epidemiological evidence, and clinical trials are very particularly of a given moment and tend to present that moment as if it were devoid of uncertainty.

  9. 9.

    Indeed, his problem stems from his having walked from Sparta to Thebes, where on the road he meets his father and kills him. His father is on a chariot, not walking, and that murder leads to Oedipus’ encounter with the Sphinx and his marrying of his mother.

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Correspondence to Lennard J. Davis.

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Davis, L.J. The Bioethics of Diagnosis: A Biocultural Critique of Certainty. Bioethical Inquiry 7, 227–235 (2010). https://doi.org/10.1007/s11673-010-9230-x

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Keywords

  • Obsessive-compulsive disorder
  • Biopower
  • Diagnosis
  • Mental health
  • Psychiatric disorders
  • Obsession
  • Compulsion