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From distress to illness: a critical analysis of medicalization and its effects in clinical practice

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  • Construct validity of ‘mental illness’ remains elusive and has been replaced by the more manageable problem of reliability. Health-care professionals may reliably diagnose similar clusters of symptoms but, realistically speaking, these conditions may not be mental disorders.
  • Labelling individuals as mentally ill only accentuates the burden of disease by situating the problem within the person, rather than to engage in the difficult task of addressing the contextual elements that may be at the source of distress.
  • Drawing on research findings in the field of HIV/AIDS nursing, we can see the impact of psychiatric pathologization of women who experience treatment-induced body changes and subsequently, must accept that their response to these changes become the target of psychiatric labelling and interventions.
  • We believe that health-care providers first need to challenge the idea that distress associated with lipodystrophy should result in pathologization. We argue that nurses should be at the forefront of such an initiative because they have the professional responsibility to act as patient advocates.

Abstract

This paper is precisely aimed at exposing the limits of psychiatry's scientific claim-making and exploring how psychiatric diagnoses come to be utilized in practice and affect those who become pathologized. Drawing on research findings in the field of HIV/AIDS nursing, we portray the impact of psychiatric pathologization of women who see their bodies transformed by antiretroviral therapy and subsequently, must accept that their response to these changes become the target of psychiatric labelling and interventions. In this paper, we therefore engage with the reader in a critical analysis that exposes the tensions that exist between individual experiences of distress and psychiatric pathologization. The first section of the paper is dedicated to the presentation of a theoretical framework in which we explore the medicalization process and the ontological issues regarding psychiatric diagnoses. The second section seeks to present the results from a qualitative research study in the field of HIV/AIDS nursing and serves as a case example to foster discussions on the implications of psychiatric pathologization in clinical practice.

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