Disease Entities and Mental Health

In my series of posts on the capitalist approach to health, I noted, in particular, the relevance of disease categories. I suggested that lumping complex phenomena into discrete categories fit patterns of research funding and the proliferation of commodities (namely drugs) as interventions. I even noted Autism as an example of this proclivity.

Well, apparently, that’s how some mental health professionals are starting to see things as well. Of course, their alternatives are still pervaded with capitalist logic and a governmental focus on normality and pathology. Yet, they recognize the role played by those who fund research, the pharmaceutical industry, and even (this is something I previously neglected) the personal identifications and campaigns that have evolved around these disease categories. Imagine what would happen to that all-powerful pink ribbon breast cancer campaign once cancer is viewed more in terms of genetic composition and less in terms of bodily location. How will we define women’s health when we can’t pin everything on the breasts?

Breast Cancer Awareness Month

Being the skeptic that I am, I have never gotten too into the breast cancer awareness stuff. This month, I have gotten just downright annoyed. It was during a plane ride, when my beverage service was infringed upon by a breast cancer donation collection, that I decided that things have gone too far. Consequently, I felt quite vindicated by this recent On Point episode.

Not only have I argued that foundations (and this includes cancer research foundations) are essentially tax shelters for corporations/businessmen who want to build a positive reputation for themselves, and certainly the pink ribbon gimmick benefits corporations more than anybody, but I am also troubled by the way that these breast cancer awareness campaigns shape notions of gender and femininity.

Why is it that women's health has come to be represented by a disease that affects the breasts? Breast cancer is not the biggest health threat for women. Is it because we reduce our concern for women's bodies to their reproductive organs/capacities... is the idea of a woman losing her breasts (as opposed, say, to a liver or a kidney) that much more disturbing because it is transgressive of our image of womanhood?

And why the pink? To enforce the perception that breast cancer is inherently "feminine"?

That brings me to another point of contention, which is the whole concept of "women's health" and "women's issues." Yes, there are certain ways in which most females' bodies differ from most males'. (But even here the difference is not actually discrete. When it comes to biological sex, the reality is more complicated than our binary categories of male-female would lead us to believe.) Perhaps, even, the organs that one does or does not have can determine the types of afflictions to which one is susceptible. (On this account, it is important to note that men can and do get breast cancer; it is not only a women's disease.) All this means, though, is that you won't get prostate cancer if you don't have a prostate gland. It does not mean that the general conditions - social, economic, political, biological - that predispose certain people to certain types disease - are actually gender specific.

In other words, the focus on "women's health" locates the cause of specific forms of female suffering within the female body itself. It is women's own bodies - specifically the parts that are marked as feminine - that bear the responsibility for affliction.

Women suffer because they have breasts.

Nowhere in these "women's health" and breast cancer awareness campaigns is any attention paid to whether or not women have equal access to healthcare; whether they receive the same treatment/respect by health professionals (in terms of their personal ability to act and make decisions; the assignment of moral culpability; the risks that are taken; and the expectations as to their ability to cope and recover); or how social norms and gender stereotypes may affect women's attitudes toward their own bodies and health. Just examples.

When I see pink ribbons on products, I see coporations yet again exploiting women for profit.

The Pharmaceutical Industry and Intellectual Property

Going along with the HIV/AIDS theme, I read an article in the New York Post* that discussed, in part, how HIV drug costs remain high despite (that is the tone of the article; I would say in order to sustain) an enormous amount of profit from their sale:

"HIV drug profits are exceptionally high, as indicated by the 37 percent earned on sales in 2010 Gilead, the leading HIV drugmaker.  This is twice the general profit level in the pharmaceutical industry, which is itself substantially higher than in most industries."

One sentence, in particular, contained one nail-on-the-head truth, and one falllatious myth of neoliberalism:

"Federal and state governments can no longer afford to subsidize the lofty profits that were useful when new HIV drugs needed robust incentives for quick development."

First, it is absolutely true that by sponsoring programs to make HIV treatments more affordable for low income individuals, the government is essentially subsidizing the massive profits of the pharmaceutical companies. That is why this "charity" approach is far inferior to a more systemic challenge of the legitimacy of intellectual property laws.

But that brings me to the myth. The idea that large monetary incentives are necessary to promote innovation has reached the level of taken-for-granted, common-sense hegemony.

Of course creativity requires guaranteed monetary incentives. That is why human beings created nothing at all until the concept of intellectual property was developed a century or so ago.

The problem is, the notion of "intellectual property" rests on premises that are not compatable with the actual nature of cultural production. The best way to illustrate this nature is through a linguistic metaphor. Literary theorist Mikhail Bakhtin famously described the way in which every linguistic utterance mimics a pre-existing pattern of speech (associated with a particular group of people and related to the group's other socio-cultural attributes). Although each individual in theory possesses infinite creative capacity in terms of what she or he can say (language is infinite), in practice people almost always repeat bits of speech (sentences, phrases, grammatical stylings etc.) that they have already heard in their particular social milieu. The true nature of innovation and change lies in the way in which people take the words of others and (in the words of Bakhtin) populate them with their own intentions, as well as bring them into new combinations with the words of others.

Following Bakhtin, other cultural theorists have argued that innovation of any kind occurs through novel melding of material from other individuals.  Thus, creativity is not an individual endeavor.  In fact, creativity requires "plagiarism."  I am reminded of an excellent quote by Chris Martin, the frontman of the band Coldplay:

"Well, you know, I think as we go further and further from just being influenced by Radiohead to being influenced by lots more people... It's just blatant plagiarism.  I mean, all that we've done, really, is expanded our plagiaristic palate."

If creativity requires a free flow of ideas, then the existence of intellectual property actually inhibits, rather than promotes, creativity.

Where did this concept come from then? Very simply, it is a quite effective way of legitimizing monopolies. That is the only purpose the concept of "intellectual property" has ever served, and the pharmaceutical industry is an exemplar, not an aberration.

Furthermore, pharmaceutical companies patent genetic material (obviously something they can't "create"!); often they solicit indigenous communities around the world to share information regarding local plants and herbs. Once the genetic material is patented, these groups no longer have the free access they enjoyed before! There is no way to argue that this practice encourages innovation. The pharmaceutical companies employed no intellectual effort of their own to obtain this knowledge (except, perhaps, for preparing the necessary legal conditions that allow them to do this). It is much more akin to "stealing" than innovation.

Intellectual property does not protect artists, writers, or inventors.   It protects the corporate oligarchy.   If we want to fight this oligarchy, we must challenge the notion of intellectual property.

*"We can change the reality of AIDS" by James Driscoll

AIDS and the World System

In honor of National HIV Testing Day...

I mentioned before that there is a strong connection between disease and political economic processes.  For one thing, disease often follows lines of marginalization and exploitation.  Not only does it tend to appear within conditions of poverty (which, let us not forget, is always caused by exploitation), but also among stigmatized populations, in areas where infrastructure has been weakened, where the environment has been degraded due to industrial development, etc.  The situation is magnified when certain groups of people become solely associated with a particular disease and attributed all the blame, as a result of their "primitive," "backward," or "sinful" behavior.  (AIDS has been branded as a gay disease and a black disease, for example.)

It is also interesting to consider the extent to which patterns of disease are correlated with large-scale economic cycles.  For example, it seems more than pure coincidence that the Black Death, one of the largest multi-regional epidemics of disease in history, occurred on the heels of an economic downturn that was the prelude to the one of the greatest periods of economic stagnation the world has yet seen.

It is reasonable to suppose that we are currently headed for a comparable phase of stagnation.  (It is more than a simple "recession" or "downturn" or blip on the radar.)  So, it is also interesting to consider that the AIDS epidemic came to light near the beginning of this latest period of economic stagnation, which started in the 1970s.  Coincidence?

At any rate, it's an interesting thought.

Food Inc.

After receiving a couple of enthusiastic recommendations for the film, Food Inc., I had to see it. I heartily recommend it myself, and I think it illustrates several points I have been trying to make regarding the inherent nature of capitalism:

Overproduction
The result of production directed toward profit rather than actual human need.   Food Inc. details how government subsidies of corn and soy have yielded a surfeit of these crops, which are not necessarily the most nutritious sources of calories.  Rather than shifting production toward other, more nutrient dense crops, we instead devise ways to manipulate the chemical components of corn and soy and recombine them so that they serve as the basis of most of our food products.

Monopolies
The hallmark of capitalism.   Limitations to compeititon are necessary for accumulation of wealth. Capitalism takes these limits to a new level.  Over the past decades, fewer and fewer corporations have gained control over an ever expanding share of the world market.  Food Inc. reveals how a handful of corporations have come to control the food industry, despite the increasing variety in actual food products.   For example, a single corporation is aiming to control 100% of meat production in the U.S., and they are not too far off.

Related to monopolies is the concept of intellectual property, a topic which I will revisit in much greater detail sometime later.   For now, I will simply point out that the purpose of "intellectual property" is not to protect or encourage innovation; it has always been a means of creating monopolies.  Food Inc. demonstrates this to great effect with the example of the patenting of genetic material in seeds.

Progress?
Food Inc. provides a good counterpoint to the hegemonic image of "progress." As I have argued before, technological innovation and industrial efficiency are a double-edged sword. In the case of agriculture and food, Food Inc. reveals how mechanization and industrialization are responsible for deteroriating diets, contaminated food, exposure to new pathogens, antibiotic resistance, and environmental degredation.

Conquering disease?
I argued in my first (yes, there will be another) series on health that the perception that we are conquering death and disease is patently false.  Food Inc. shows how epidemics, diseases, and other health threats have been created by the forces of modernity.

Curtailment of Liberties
I have also argued that there is no such thing as a "free" society. At least, not among the modern system of nation-states and colonies. Capitalist interests not only limit the freedom of the market, but other freedoms as well. That is why "democracy" is an illusion. Two cases in point, as shown by Food Inc.

Number one, Food Inc. provides an example within the area of agriculture and food safety of the way in which the governmental functions of the state and supposedly "private" capitalist interests are actually intertwined. The idea that there is a separation between "business" and "government" is pure ideology.

Number two, Food Inc., with its discussion of "veggie libel" and lawsuits pursued by the meat industry, also shows how the protection of personal liberties is constrained by capitalist interests. We have freedom of speech... unless it threatens corporations.

My one critique of the film is that the producers are quick to jump on the "organic" bandwagon, giving such enterprises very one-sided support and abandoning the critical lens employed throughout the rest of the film.  If the organic enterprises are owned by the same corporations responsible for all the horrors described in the rest of the film, then why would their profit-driven practices not affect the organic industry as well?

All in all, though, very worthwhile and eye-opening.

Health Myth 7: We Can Conquer Disease and Death

We spend a lot of time and money trying cure diseases. Owing to the ideology of progress, we have faith in the near inevitability that any given disease will eventually be cured, if only we devote enough research to it. Those who envision a future in which all diseases have been cured (most eradicated), allowing us to live long lives before dying peacefully of old age, are generally not considered pie-in-the-sky idealists.

Clearly our belief in progress necessitates a certain view of health as "conquest" (just as political and economic progress entailed colonial conquest). Progress involves the subordination of all things to human (generally means certain humans) control. But can death and disease ever be entirely within our control?

First, consider: everyone dies. Some people have noted that as the death rate from one disease goes down, the rates of others, by necessity go up. Is this really an accomplishment? Curing and preventing diseases never lowers the rate of death!

You may argue, "Yes, but by combating [another militaristic metaphor!] disease, even if those potentially affected die anyway, at least we have eliminated the suffering caused by that illness." True. But remember, old age comes with its own forms of suffering: mental deterioration, physical weakness and pains, accidents resulting from impaired abilities, etc. Eliminating a disease does not by any necessity reduce suffering in the long run. It might. But it might not.

"Maybe we could control that too. With medical advances, we could eventually prevent the mental and physical deteriorations of old age!" However, by believing that we can eventually control everything, we are once again relying upon the model of simple, linear causality, that is ultimately inadequate to account for a complex system like the human body. The environment is constantly changing in ways that we cannot predict (by virtue of the fact that it, too, is a complex system), and therefore the body will always be responding to these changes in unforeseen ways. The growth of antibiotic resistant bacteria is only one of many ways in which our world continues to transform itself.

To eliminate death and disease, we would have to be able to bring every single aspect of our living environment under our control. Unfortunately, the properties of complex systems and chaos make this goal completely unattainable.

Myth 6: It is Normal to be Healthy

Although it is obvious that everyone gets sick at some point, we tend to treat illness as if it were some form of a "deviation" from a normal state. Likewise with disorders, syndromes, etc. It is as if there were one particular way the body is "supposed" to function, if not affected by assaults from without or perversions within.

But the body is a complex system. It is the very nature of a complex system to embody multiple physical configurations and to respond in highly unpredictable ways to changing conditions - to itself be constantly undergoing processes of change. Thus, thunderstorms, though possibly unpleasant or even dangerous, are requisite aspects of weather systems, following directly from their internal logics, as much as nice, sunny days. The same with illness and disease.

Furthermore, what it is to be "healthy" is itself a socially determined matter. No one is exactly the same; no body functions identically to any other. We are all unique and have our individual quirks, strong points, and weaknesses. So what, exactly, is the boundary between "healthy" and not "healthy"? If I have allergies, am I still healthy? My muscles are a little less flexible than the average person, and my ankle joints are tight... does THAT make me unhealthy? Is a person with lactose intolerance (coincidentally, a much more prevalent "condition" than lactose tolerance) still healthy? What about a hemophiliac? The lines we draw are arbirtary. But they do have meaning.

I mentioned in Myth 5 that the religious aspect of the "invasion" approach to disease has only partially been shed from contemporary thought. Although modern medicine is an ostensibly "secular" enterprise, the moralization of illness and disease still persists (and, in fact, is vital to the narrative of progress). It takes the form of a pervasive yet tacit assumption that health status is a measure a person's moral worth. Disease is often associated with unhygenic, "primitive," or deviant behavior. It also tends to become associated with particular groups of people (AIDS was a "gay disease" before it became a "black disease"; hepatitis is a druggie disease; syphillis is a pervert disease; TB is an immigrant disease; etc. etc.). Our notions of "health" and "disease" are a significant means by which we imbue human bodies with social meaning.

In the era of capitalism, we may do this to create social divisions among the human population to enact a division of labor; to construct a visual map of scientific/capitalist progress using human bodies (a task which requires contemporary representatives of our "primitive," diseased past); to evaluate and manipulate personal choices; and, of course, to sustain a consumerist attitude toward physical well-being, wherein if one just "tries hard enough" by investing wisely in food, in doctors, in pharmaceuticals, etc. then one can attain "health."

Myth #4: Diseases are Discrete Entities

Modern medical practice is essentially built upon the idea that deviance comes in discrete packages ("disease," "infection," "disorder," "syndrome," etc.). This leaves the following tasks for medical researchers and health practitioners:

1. Refine the definition of the deviance-entity; draw sharper boundaries.
2. Improve the process by which it can be recognized according to its symptoms.
3. Identify the cause(s).
4. Discover potential treatments.

If a patience presents a heretofore unencountered set of symptoms, medical professionals immediately attempt to determine "what" this person "has," and isolate the essence of this newly discovered entity.

This regimen has produced two major tendencies:
1. The proliferation of diseases and disorders. As new realities are encountered, new entities are devised to account for them. Additionally, new diseases mean new research programs, new grants, more journal articles, more conferences, different ways to market treatments: in effect, more ways to circulate capital and sustain the work of those in R&D fields.

2. Growing prevalance of certain diseases. In part, this occurs when new experiences are not separated into new disease categories, forcing already existing ones to expand. And in part, this results from the pathologizing of characteristics that were previously viewed in a different light. Once again, from an economic standpoint, escalating rates of disease mean expanded investment in research and increased markets for treatments.

This is not to say, of course, that capital investments are the only (or even most important) driving force behind these tendencies, or that the medical establishment does not accept these premises concerning the nature of disease with all intellectual sincerity.

However, this does highlight the way in which our propensity to view health in terms of discrete, material entities is shaped by a capitalist organization of social institutions (including those related to medical research and public health), in which capital investments are discretely categorized and allocated according to quantifiable outcomes; goals and results are measured in terms of material inputs; and individual human bodies serve as the primary site of intervention (as opposed to integrated social processes).

This all occurs in the face of one undeniable fact: it is really hard to define diseases in such a way that they may be sustained as discrete entities. In actuality, we don't discover diseases; they are not just sitting there, waiting for us to learn of their existence. We create diseases, disorders, syndromes, etc. Faced with a complex and variable reality, we impose categories upon our experience in order to simplify and more easily understand it. Oftentimes definitions of diseases are based more upon history and accident than on any coherent set of principles. Furthermore, a single disease may present such widely varying symptoms that any two people may experience it in entirely different ways, and the causes may be multiple or unknown. (Autism is a great example.) Why, then, should it be considered a single "thing"? Still, we proceed as though the categories that we have created have an essence and an existence all of their own, and our task is to simply discover what that essence is.

There are significant social and political implications as to what behaviors and conditions become pathologized (or de-pathologized, in the case of the removal of "homosexuality" as a psychiatric disorder). What we see as a "problem" is deeply socially embedded. It should also be noted that the creation of "problems" is, in itself, a strategy that is employed by dominant forces to mobilize social and political resources, as well as capital flows, in the service their own agenda. Not that every new disease is a conscious and strategic creation of a conspiring economic elite, but one should be aware of the way in which this generalized (and non-uniformally applied) strategy can be employed in the domain of health.

Capitalism and Health

I decided that I wanted to devote a number of posts to the subject of health.  The way we view and act upon the human body is a concern of central political, economic, and social importance, as well as instrumental to the way in which we perceive ourselves as individuals.  To start, I will provide an overview of the capitalist approach to health that has become so pervasive and naturalized.

This approach entails the following assumptions:

1. It is the "normal" state of affairs to be "healthy." Thus, ill health and other physical maladies are a form of deviance.

2. Deviance comes in discrete packages: "disease," "infection," "syndrome," and "disability" are the most common. Each form of deviance, in turn, has a discrete and identifiable cause. Some causes represent inherent abnormality (genetic defects); some represent outside threats (bateria, viruses, fungi) which can be managed and prevented; and some derive from behavior. Furthermore, to the extent to which susceptibility to "outside threats" is determined by "inherent abnormality" and behavioral causes, its role is more that of a secondary cause.

3. Health is managed at the level of the individual, in terms of individual defects and behaviors. In this way, each individual often becomes directly culpible for his or her own health, and public health strategies focus on "education" and the management of behavior (encourage kids to exercise, regulate salt content, tax cigarettes, etc.). An ideology of "personal responsibility" and the employment of governmental power relations (two non-contradictory components of capitalism: both seeking to effect change at the level of the individual) are the name of the game.

4. Understanding of causation is extremely linear and material. A one-to-one correspondance is often sought between illness and personal hygiene, eating habits, level of physical activity, and engagement in "risky" (i.e. non-socially sanctioned) behaviors.

5. With discrete, material causes of health-related deviance, the restoration of "normality" may be pursued by equally discrete, material means: thus, the domain of health care is easily penetrated and transformed by capitalism and its tendency toward commodification of every possible aspect of life.

The following are some examples of the "simple math" that has characterized our approach to health:

-People with heart disease are often fat. Therefore, being fat must cause heart disease. Furthermore, you must be fat because you eat fat. Consequently, a low-fat diet will prevent heart disease. Oh, how convenient, now we have created a market for I Can't Believe It's Not Butter!

-If you have chest congestion and fatigue, you probably have a respiratory infection. Infections are caused by outside agents. Outside agents must be killed by antibiotics (because the human body is not designed to deal with bacteria and viruses on its own). Oh, how nice for the pharmaceutical companies, people are willing to pay lots of money for drugs! (Oh, too bad for the poor people who actually need them but can't afford them...)

-Syphillis is a sexually-transmitted infection. Since syphillis is a "deviant" condition, it must result from deviant sexual behavior. Therefore, only people who deserve to get syphillis get syphillis. Hey, why not use poor black people with syphillis for the unnecessary medical research that supports our gainful employment? If we treated them, we would only be shielding them from the consequences of their actions anyway.

-Everyone's body is, ideally, exactly the same. If someone's body deviates from this ideal, it must be their fault. They should live in constant guilt and shame. They also should spend an inordinate amount of time, energy and money trying to become closer to the ideal. Since practically nobody is "normal," what a large market that creates for diet products, exercise equipment, fancy scales, and magazines with helpful tips on how to "get the abs of your dreams" (or, just for Schadenfreude, investigations into which celebrities have gained 2 pounds)!