Thread by @alexhaagaard

I actually have an answer for this!

It comes back to the issue of medical (in)visibility.

Clinical medicine was founded upon the logic of pathology; it became concerned with mapping illness to visible (and eventually measurable) sites of pathology…

https://twitter.com/disableddoctor/status/1406708325727756294

At roughly the same time as “the birth of the clinic” the period following the French Revolution saw the abolition of social institutions associated with the Ancien Régime, including the previous system of “bedside medicine”…

…so that the medical system in the French Republic became reoriented with the hospital at its center. The hospital brought together large populations of destitute sick people, and a new “collegiate” community of professional medical practitioners.

Per Dr. Mark Sullivan, a physician and philosopher of medicine, the relationships between these populations became organized, “around a nexus of formally defined statuses and strictly defined patterns of deference.”

Thus, the role of the patient, in its modern sense of one who waits and forebears as the passive object of clinical intervention, emerged - and with it, the role of the bad patient, as one who resists or challenges these patterns of deference and acquiescence.

Going back to the issue of medical invisibility, symptoms and illnesses that cannot be mapped to pathologies constitute a challenge to the authority of clinical and pathological ways of knowing.

So, the sick people who present with them are themselves a challenge to the clinic, and this they become bad patients.

Thus, their deviance is moral rather than somatic, and they must “want to be sick.”

The fix for this is to abolish the clinic.