Distinguishing Medical and Social Problems

Immigrant Family in the Baggage Room of Ellis IslandProblems are messy, so to solve them, humans quite naturally move to make them tidy. We sort them, label them, and get to work on resolving them. But news this week reminds us that health issues often resist our efforts to sort them out and find tidy solutions. The USPSTF this week published a draft recommendation to routinely screen adults for anxiety and refer them for care. This raises questions about the medical and social dimensions of problems with mental health. Because both are surely part of the challenge we face with a rising prevalence of anxiety.

Likewise, obesity is indeed a medical problem for many people – too often, a severe one. But in addition to the medical dimension of obesity, it has important social dimensions. Fat activists argue that social bias and stigma cause them greater distress than obesity itself, and they have a point.

So it’s worth taking a moment to think about how we might do better at dealing with both the medical and social dimensions of  problems like obesity or anxiety.

The Question of Medicalization

Professor Danielle Carr offers up a thoughtful consideration of medicalization in the context of mental health. She explains that concept as a way of framing a problem with social, political, and biological dimensions as something that is purely a medical problem. It’s a particular expression of the reification fallacy. She describes how it can over-simplify complex problems with mental health:

“Medicalization shifts the terms in which we try to figure out what caused a problem, and what can be done to fix it. Often, it puts the focus on the individual as a biological body, at the expense of factoring in systemic and infrastructural conditions.

“Once we begin to ask questions about medicalization, the entire framing of the mental health toll of the COVID crisis — an ‘epidemic’ of mental illness, as various publications have called it, rather than a political crisis with medical effects — begins to seem inadequate.”

Providing Care While Attending to Social Factors

To date, both healthcare and public policy have generally failed in dealing with either the medical or social dimensions of obesity. Progress in finding more effective treatments for obesity is considerable, but access to that care is poor. And meanwhile, relentlessly rising obesity prevalence suggests that policymakers are failing to address the social and environmental factors that are triggering it.

Likewise, Carr argues for doing more than just screening for and treating mental health:

“Solving the mental health crisis, then, will require fighting for people to have secure access to infrastructure that buffers them from chronic stress: housing, food security, education, child care, job security, the right to organize for more humane workplaces and substantive action on the imminent climate apocalypse.”

In the face of problems that arise from a harmful or even hostile environment, people need care for those problems. But we all need to work at repairing the environment that’s fueling these problems.

Click here for the essay by Carr, here and here for more on the recommendation on routine screening for anxiety. For further perspective on the interaction of social, political, and medical problems, click here and here.

Immigrant Family in the Baggage Room of Ellis Island, photograph by Lewis Hine / WikiArt

Subscribe by email to follow the accumulating evidence and observations that shape our view of health, obesity, and policy.


September 22, 2022