The Case of Premenstrual Dysphoric Disorder

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This week on Imperfect Cognitions, we showcase a few posts by authors with papers revealed in a particular subject from the European Journal of Analytic Philosophy (EuJAP). The particular subject is on the Philosophy of Medicine with visitor editors Saana Jukola and Anke Bueter. 

In right this moment’s publish, Anne-Marie Gagné-Julien discusses her paper within the particular subject, which you’ll learn here. Anne-Marie is a postdoctoral fellow on the Biomedical Ethics Unit at McGill College and in addition affiliated with the École normale supérieure (ENS). She works on philosophy of psychiatry and medication, social epistemology, and epistemic innocence. 

Anne-Marie Gagné-Julien

Medicalization is the method via which nonmedical issues are conceptualized and handled as medical issues (Conrad and Slodden 2013). It has turn out to be a controversial matter each inside and out of doors psychiatry, particularly for the reason that publication of the fifth version of the Diagnostic and Statistical Guide of Psychological Issues (DSM-5). A number of critics have argued that the DSM-5 medicalizes situations that ought to solely be thought-about “regular life issues”, “harmful items”, or minoritized methods of being. Some particular revisions within the DSM-5 have been obtained with nice suspicion, such because the diagnoses of main depressive dysfunction, bipolar dysfunction in youngsters, persona problems, and premenstrual dysphoric dysfunction. 

From a philosophical standpoint, this raises the query of methods to assess the medicalization of those diagnoses. Though medicalization in psychiatry is mostly mentioned from a essential perspective, the time period itself is neither constructive nor destructive in itself: typically medicalization can deliver good penalties, corresponding to entry to assets and reducing blame related to medicalized situations. Typically it might probably result in dangerous penalties, corresponding to seeing all people’ issues via a biomedical framework and spawning pointless medical interventions. Due to this fact, what seems problematic are the dangerous types of medicalization, or what I name “wrongful medicalization”. Relating to the various penalties and implications of medicalization, figuring out circumstances of medicalization which are wrongful is a troublesome endeavor. In different phrases, “what’s a wrongful medicalization?” is a posh query.

Within the paper, I suggest to discover these points with the philosophical framework of epistemic injustice (EI, e.g., Fricker 2007). EI are the harms suffered by people belonging to socially oppressed teams of their capacities to provide, entry and/or share data due to prejudicial id stereotypes (e.g., racism, sexism, ableism, and so forth.) or due to their social marginalization. The place medication is anxious, Kidd and Carel (2017) have depicted a specific type of EI that considerations prejudices related to the expertise of sickness. It happens when the data of sick individuals is dismissed, not even appeared for, or confined to a purely biomedical discourse. As some have argued, the danger of encountering such a EI is even higher in psychiatry due to widespread destructive stereotypes related to psychological sickness.

Utilizing this framework is helpful to consider what wrongful medicalization is. Within the paper, I give attention to Kaczmarek’s (2019) promising pragmatic strategy to assessing medicalization. Utilizing EI, I argue that Kaczmarek’s proposal lacks steering in regards to the procedures via which we’re to evaluate medicalization (e.g., what mannequin of dialogue is probably the most fruitful to consider wrongful medicalization? Who ought to be included in these discussions and why? and so forth.). 

I exhibit that the EI framework ought to complement Kaczmarek’s account with the intention to scale back the danger of epistemic injustices induced by medicalization, and subsequently the danger of wrongful medicalization. As an example the relevance of my proposal, I apply this conclusion to a case examine: the medicalization of Premenstrual Dysphoric Dysfunction (PMDD) in DSM-5. This leads me to defend extra inclusive decision-making procedures relating to medicalization of PMDD within the DSM. I argue that Kaczmarek’s account complemented with the EI framework may also help us obtain higher types of medicalization in psychiatry.



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