We like to believe medicine exists solely to heal. History tells a different story.
From slavery to women's dissent, from homosexuality to neurodivergence, medical authority has repeatedly been used to define resistance as illness and compliance as health.
This video explores how diagnosis has been shaped by power, how difference has been pathologised, and how mental health is increasingly used as a tool of governance in schools, workplaces, welfare systems, and politics.
It argues for a politics of care that treats difference as human variation, not disorder, and asks whether medicine can be reclaimed as a genuinely liberating force rather than an instrument of control.
This is the audio version:
This is the transcript:
Medicine is not neutral. We'd like to think that it is. We'd like to think that medicine, doctors, the whole medical health industry, all of it is there to promote our well-being, but that is not the case; history shows otherwise.
The fact is that medicine and mental health treatment in particular has repeatedly been used to suppress people within society who politicians think do not conform to the expectations of the norm that they wish to impose upon us. Again and again, difference has been defined by medicine as disorder, and that is still happening today. The costs have been enormous, and we need to talk about this.
This video started with the review of one obscure historical diagnosis that I'll mention in a moment, but in truth, it's all about a political pattern that keeps repeating. When people resist, refuse, or simply do not fit into what those with power in society want, they use medicine to define these people as aberrant. They don't listen to them. They instead use the power of the medical profession to label, manage, and discipline people so that they conform to what society expects.
This whole video started when my wife said to me, "Do you know what drapetomania is?" And the honest answer was, of course, no, I didn't. I had no idea what it was because I had never heard of it, and I strongly suspect that you haven't. Well, it was a medical diagnosis created in 1851 by a doctor in the USA who said this idea - drapetomania - explained why enslaved people tried to escape. But what it actually did, of course, was redefine a desire for freedom as mental illness. Resistance was made pathological, and obedience was redefined as mental health. The slave who wanted to run away was described as requiring treatment through what was, effectively, , violence, and punishment became "care".
The whole purpose of this diagnosis was to reinforce an economic system based on exploitation, protecting the ownership of slaves from challenge as a consequence. This was medicine made into political economy; it's medicine made into power.
And you could argue, of course, that this was a one-off error or just bad science of that particular moment, but it wasn't ; that's not true. The idea that non-conformity is, in fact, to be seen as mental illness is something that has gone on throughout the history of medicine.
Compliance in the name of healthcare has been enforced time and time and time again.
We've seen it with women. The same logic was applied to them when they dissented from patriarchal power. Their anger, their ambition, their sexual autonomy; they were all medicalised. Hysteria was turned from dissent into a diagnosis, and literally, women were locked up for disagreeing with patriarchal power. This was enforced through clinics rather than through courts, but the effect was absolutely devastating.
Women had to fight the most extraordinary prejudice to get to where they are in the world now, and let's be honest, they're still suffering prejudice. The idea that women cannot partake in society on equal footing still exists. Hysteria is still used to describe "stroppy people," and the fact is that this is the medicalisation of difference, and we've seen it elsewhere as well.
Homosexuality was officially classified as a mental disorder throughout decades of this century, and love for another person of the same sex was treated as deviance. Literally, criminal prosecutions followed, but so did medical treatment. Look at what happened to Alan Turing, who effectively died as a consequence of chemical therapies applied to him by force as a consequence of his homosexuality. He committed suicide in 1954, precisely because the medical profession was used to suppress his identity and not to support his well-being.
Now we're seeing the same issue again, which is happening over trans rights; whichever side of that argument you are on, it's being medicalised in a way that is wholly inappropriate.
The same is also true with regard to neurodivergence and everything that goes around it. Autism, ADHD, dyslexia and other differences are framed as if they are deficits when they're not. They might be superpowers, but they mean that a person does not comply with the norm. And so a way of thinking, a way of sensing, a way of communicating that diverges from that normal is medicalised as a consequence, and the whole language around this makes that clear.
Neurodivergence is a negative; it is not a positive. It implies that there is a normal, which is right, and that this is wrong. Difference is still being treated as a problem to be fixed.
In schools, children are disciplined for not sitting still or not concentrating in prescribed ways, or not complying with behavioural expectations when they have no chance of doing so because of who they are.
In workplaces, productivity norms assume a narrow model of cognition, but many people aren't possessed of that model, and so they are forced to the edge of the career structure or just out of work as a consequence. And welfare systems still demand proof of incapacity whilst penalising difference. Diagnosis is becoming an economic gatekeeper as a result, not just a support, but to reinforce legitimacy and to force some aside.
There is in this a crucial social distinction. Support has come to mean forcing people to adapt to systems, and discipline has come to mean forcing people to do the same thing.
We see this inside the benefit system. People are disciplined because they cannot time-keep, but some people are just unable to do so. And it is wrong that they are penalised as a result. What they need is understanding, not penalty, yet what passes for mental health intervention does, in too many cases, become punishment precisely because that is what capitalism and neoliberalism require.
Mental health is becoming politically focused as a consequence. It is being used to define what counts as normal, and normality is then used to determine what employability means and, in consequence, what social worth is. All of those things are creating definitions of those who are also marginalised, managed, or excluded.
This is systematised abuse as a consequence. Those who are not normal are being punished. Capitalism requires predictability, standardisation, and compliance, and neurodivergence disrupts these requirements. The consequence is that those who are neurodivergent are being penalised, as were women, people who were gay, and those who were slaves in the past. Diagnosis is not being used to restore order. It's being used by institutions to try to correct individuals and to force their compliance.
What is more, the cost of adjustment is pushed onto those least able to bear it. It isn't the state that's bearing the cost of becoming normal. It is the person who is supposedly abnormal who bears this cost, and we are seeing this throughout our society. Everyone who opposes is penalised. This is also true of politics, of course.
And structural failure to manage differences is being reframed as personal pathology as a consequence. Burnout becomes a lack of resilience. Distress becomes maladjustment, and inequality becomes a psychological problem, and systems escape responsibility for all these things as a result.
Medical expertise is then not independent of power. In fact, power is being used to inform medical expertise and, in turn, to shape society.
Diagnostic categories are reflecting social norms, and research priorities reflect funding structures. The consequence is that the medical profession is actually closing itself down to challenge, whilst lived experience is treated as anecdote.
This is deeply dangerous. The state is embedding these dynamics in policy, whether that be medical policy, or education policy, or welfare policy, or employment strategy, as well, and the state legitimises all of this through law and regulation.
What a politics of care would look like would be decidedly different. It would, in fact, start from that precise word, "difference". It would accept that difference exists and that this is not deviation. It would adapt institutions rather than forcing conformity. It would separate support from coercion, and it would treat distress as information about systems and not as failure within individuals. This is critical.
We need to work in ways that recognise that there is no one uniform human being, that dissent is to be encouraged because it indicates the way in which progress can happen, and that difference is simply an expression of humanity, and nothing more or less than that. But we live in a world where humanity is being undernourished and ill-treated, and that is what worries me, and that is why I do believe so passionately in a politics of care where freedom and difference and dissent are not called illness, but are literally respected for what they are: characteristics of human behaviour.
This also means that we have to reappraise what medicine is. It has become a tool for governance and oppression, but it cannot be that. Our task is not to reject what it does, but to refuse to accept its use as a tool that literally constrains people. Medicine is of value, but its use in this way is not. We have to, therefore, name that oppression now because unless we do, there won't be a change, and there won't be an apology for the abuse that has happened, and there cannot be reform.
We need to look at medicine in a different way. Medicine should be liberating; it should treat, but not condemn, and it should empower us and not literally push us to the sidelines. When it does that, empowerment, instead of that sidelining, we will know that medicine has joined the mainstream of society again. At present, that's open to question.
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Not being able to cope with variety has always been a symptom of a parsimony (extreme stinginess) based on either a partiality to one’s ignorance or false notions about money being in short supply or both.
This is what also drives AI and automated customer relationship systems as well as too much of capitalism – the idealisation of customer need, not realisation and satisfiance of actual customer need.
Therefore, a very timely post in the crucial area of public health.
Thanks
Sadly I agree with your arguments. As a society we have become more Intolerant of difference, hence the current obsession with what is termed neurodivergnce. Schools and workplaces have become places that are a nightmare if you don’t fit the norm. Instead at looking at why a neurodivergent child/adult is struggling and seeking to make the whole environment more inclusive, they are othered and set apart. Whilst there are people totally disabled by such things, I personally think a bit of kindness and acceptance of difference would go a long way to help everyone. And as someone having a crash course in neurodivergnce maybe we should be educating the rest of the world into understanding and making more effort, rather than labelling us different/difficult. I will still be the same person following my likely diagnosis this week, I will just be able to legally demand accommodations in a world increasingly hostile to my way of being.
Your points are good. The last is unfortunately true, and why “diagnosis” rather than simple recognition is required. But even the term “diagnosis” is wrong: it implies illness when there is no such thing. There just has to be recognition of what is.
Totally agree. I am so grateful to have an amazing boss, whose comments about my likely designation were that I was doing a good job and he needs more of it in his life, which I assumed he meant my off the scale attention to detail. If only there were more people like him!
I like attention to detail!
Individual differences are the cornerstone of evolution! And necessary for a functional society. Like leaves on a tree, all are needed, from their different perspectives, to maintain the organism.
Agreed
Thanks to you and your team for another acute analytical article.
In general terms, it does seem that whatever human intelligence can discover and/or create, others can and do subvert/pervert.
More particularly, might your accurate statement “medical expertise is not then independent of power” raise relevant questions about the sources and distributions of power?
Similarly, might the state being embedded in the dynamics of medical expertise raise relevant question about who actually “steers” the state?
Might an educational set up which actively teaches-learns dynamic analytical questioning improve matters?
Ditto main stream media with its current pro-power, passively questioning information with interpretation/propaganda?
I chose to seek diagnosis, it has helped me understand myself and forgive myself for not managing to fit myself into the round holes I once felt I needed to adapt myself to. I embrace my awkwardness more. I find the medication helpful at times; I choose when to take it. Others are not so fortunate.
When I was a student, I came across Amnesty International, and started writing monthly letters in support of the liberation of a man in the USSR who had been incarcerated and treated with drugs for years after being arrested as a young man for distributing leaflets. With age I have come to learn that abuse of medicine happens in many places, including the UK, and that in large institutions, even the NHS, for some practitioners, the only choice in the end is to leave, because changing from inside is impossible and harmful to the individual. Whistleblowing is often counterproductive.
Thank you Richard and Jacqueline for raising this topic.
It is a tough one.
And Jacqueline did contribute to this one, as is obvious.
Go on a Vintage Bus Running Day and see how easy it is to get on ever ‘relatively’ recent vehicles eg a 90’s minibus compared with todays.
Then think what its like for anyone with even slightly limited mobility – say just getting old.
Now repeat but with hearing loss, neurodivergency, not understanding IT etc etc……….
My impression is bus access has got better.
Around here access seems to be made easy.
Are you saying otherwise?
Sorry the point I am trying to make is that its an actual example where you can look and see how things were for people with restricted mobility and how they have changed – in this case for the better BUT as someone with full mobility its an example staring you in the face of things not being open to everyone and perhaps you can extrapolate it to other things
Understood now
My sense is that a collective idea of what is ”normal’ has been around for a very long time when what was feared in medieval times in communities was reviled and ostracised. When national government became concerned about individuals rather than leaving things to local lords this was adopted as a power strategy and the emergent medical profession with its proliferation of extraordinary theories and treatments was a neat box in which to place those who didn’t conform.
This history of conformity must also bring into question whether to some extent we have bred certain characteristics that promote the majority view of what is beneficial and neurologically marginalised those that differ.
In any case, it continues to be a story we are told that it is better to be inside the fold than outside and this is applied not just to medicalised difference but geographical difference as well.
The medical profession has always been dominated by public school products, trained with the attitudes of our colonial and imperial past. Since World War 2 more middle class and even (god forbid!) working class entrants. However with our meritocratic socialisation ,unfortunately this trend continues. However with more militancy growing such as the willingness to strike, establishment norms may be weakening.
I am struggling, Bill. What i your point?
Todays medical profession is very different to the profession that was led by Sir Lancelot Spratt and its approach to conformity is changing even if the experience of Palestinian Doctors in the UK is not a happy one
I think there is another aspect to neurodivergence too.
I asked AI to summarise the traits and characteristics of psychopathy, here is what came back.
Traits of Psychopathy:
Psychopathy is characterized by a range of emotional, interpersonal, and behavioural traits. Here are the most common traits exhibited by individuals with psychopathic tendencies:
TRAIT DESCRIPTION
Lack of Empathy Difficulty understanding or caring about others’ feelings.
Superficial Charm Engaging and charismatic demeanour that masks their true nature.
Manipulativeness Tendency to manipulate others for personal gain or gratification.
Grandiosity Inflated self-worth and belief in their superiority over others.
Impulsivity Difficulty in controlling impulses, leading to risky or reckless behaviour.
Irresponsibility A pattern of failing to fulfil obligations and commitments.
Shallow Emotions Limited emotional responses, expressions of feelings may be exaggerated or insincere.
Deceitfulness Frequent lying and deception; using false identities or stories.
Antisocial Behaviour Disregard for social norms and rules, often engaging in criminal activities.
Need for Stimulation Seeking out high-risk activities to satisfy boredom or restlessness.
Additional Insights:
Individuals with psychopathic traits may appear charming and engaging initially, but their underlying motives often include manipulation and exploitation of others. They typically display a profound lack of remorse or guilt for their actions, which can lead them to commit unethical or harmful acts without consideration for the well-being of others.
It’s important to note that psychopathy exists on a spectrum and not everyone displaying these traits is a violent criminal. Psychopathy is assessed using standardized measures, such as the Hare Psychopathy Checklist, which evaluates these traits across different domains.
Sorry Richard, that got sent prematurely, while I was trying to format the AI response that I had pasted in.
The point that I was trying to make was this:
How many of our politicians, business leaders, all those who shape society; would if tested, be diagnosed as having psychopathic traits?
Perhaps, as a society, if we were to try and ensure that such people never got to high office, then the world might be kinder.
May I offer what I believe is a very important clarification, Richard? You are not talking about medicine in its entirety. You are talking about the specific discipline of psychiatry. People who have committed no crime cannot have their liberty taken away indefinitely simply because they have cancer. Nor can a person be forcibly medicated against their will for having a diagnosis of osteoporosis. Even the USSR never pretended it was imprisoning and drugging individuals because they had congestive heart failure.
Psychiatry is extremely vulnerable to manipulation by bad actors; and I include a very small number of psychiatrists themselves in that category. There is no lab test or X Ray or MRI scan that identifies the presence of illness. Diagnosis is completely dependent on a psychiatrist’s observation. A patient gives their subjective account to another person, who then makes a subjective judgement to apply a diagnosis – which in itself is only a (psychiatrist produced) name for a constellation of behaviours.
Small wonder politicians and States generally use it to their advantage.
No, I am talking about all of medicines using one discipline as an example
The whole of medicine is corrupted in this ways or it would refuse to be gave as it does on chronic illness – whochnis to pacify and perpetuate neoliberal profit maximisation and not put patients first.
Yes indeed Richard. And there is also the encroachment of politics – and particularly the government – into nominally independent medical institutions.
Its another aspect of the desperately needed constitutional reset the UK needs. Senior management in the UK Health Security Agency and NHS England and possibly even the JCVI – vaccination advisory commission seem to be appointed by government according to their willingness to implement government policy , rather than by an independent medical panel to implement established principles of public health for example
Thus even now, the general population is unaware that sars2cov is still a thing , and that it and flu are transmitted via airborne aerosols – and that ‘washing hands’ is pretty useless compared to having clean and/or filtered air and/or masking in crowded indoor spaces. There is little official acknowledgment or curiosity about those suffering long covid – or indeed why cardiovascular incidence is still much higher among younger adults than pre-2020.
When I was involved in discussions with the Independent Sage group during the covid peak of 2020-2022 it became clear there were some ‘independent’ medics/academics who would never directly question government policy, giving the distinct impression they didn’t want to jeopardise their future honours, or their public funding
Much to agree with
Sadly it frequently happens in families as well. Heaven help you if one does not fit the prevalent societal paradigm of what one “should be” look like or act like over the various ages of your life.
Were you aware that the word ‘hysteria’ is derived from the Greek word ‘hystera’ meaning uterus. Only those with womb can suffer from hysteria
I am – hence why I referred to it in that context.
The ancient Egyptians first believed that the cause of women’s’ psychological ailments was the womb “wandering”, and the Ancient Greeks accepted that. Hippocrates called it “hysteria”. St Augustine believed that sin was the cause of human suffering, and that hysteria was the result of satanic possession. Later, “strange” women were burnt as witches.
Hysteria as a diagnosis was only removed from the DSM in the 1980s.
I propose a new word: testerical. This only afflicts men, and manifests as extreme grumpiness, often falling into angry declarations of “fact”, unsupported by evidence.
🙂
Whilst I agree wholeheartedly with the points re treatment of difference I think that, at least, a little nuance is required.
Most of us would value societal norms… good manners, as an expression of care and consideration for others. These however do not come about by chance, by leaving people to be entirely as they are…. feral almost.
A degree of ‘conditioning’ of our children is required, a ‘forced compliance’ if you will to ensure that they are able to make a contribution to society.
As a self-professed nuero-divergent Richard that has navigated a complex and diverse path through society I’m sure that you must have excellent manners so some ‘forced conditioning’ is obviously beneficial.
I am not intending to be frivolous or deliberately antagonist here just responding to the thinking that the post has prompted.
Trump is almost certainly a product of a dysfunctional upbringing, where ‘just expressing his humanity’ has been left to run riot and consideration of the other has not been ‘conditioned’ into him. He has, if you will, been ’empowered to be himself’ with all the resultant fall-out.
As I said at the outset…. I’m struggling with the nuance.
Understood
And I get your point. Of course we have to learn to live together, but with our differences.
I have just started re-reading Naomi Klein’s Shock Doctrine, which is more relevant today than it has ever been in exposing the political strategies behind fascism.
The first chapter deals with the psychiatric shock therapy and the covert experiments conducted by the psychiatrist Ewen Cameron in collusion with the Central Intelligence Agency post WW2 in the US.
Medical shock therapy, a form of torture inflicted on captive patients, is the first step towards disaster capitalism, and the shock and awe techniques practised by governments on their enemies and their own people. If you can shock and disorientate a population, you can gain their political support. Voltaire, and Heather Cox Richardson, already mentioned on this blog today, articulate the problem just as clearly.
Thanks. Noted.
You might be interested in “The Sleep Room” by Jon Stock
I believe more people than ever before are aware of the fact that every individual is different physically and mentally. That, in itself, must be progress. In the UK, we are no longer criminalising sexual preference or sectioning people who are neurotic rather than psychotic. I’m not sure this is anywhere near enough. As you say, there is so much more that can be done to recognise differences medically. The gov are, as usual, reactive to the right-wing media and their labelling of disability as shirking or benefit fraud. They also begrudge welfare payments for disabilities.
Unfortunately, many uninformed members of the public believe the media, rather than the medical profession or the actual statistics, which creates a negative attitude to poor health. The disabled, like immigrants have become an easy target for the right-wing populists.
Covid was a great leveller and brought out the humanity of the silent majority. We need to remind the politicians and the populists that we are, by and large, decent, sympathetic people who know that any individual can become ill or disabled at any instant. It can happen to anybody.
I am frequently angered by the endless stream of articles, talk and advice on our “mental health crisis”, in particular the incidence of depression and anxiety.
There was an interesting programme aired on Channel 4 this week “Live well with the drug free doctor, ” which looked at non medical solutions to a number of common issues, depression being one, and highlighted the massive increase in the prescribing of antidepressants over the last 2 decades. The advice was generally good, especially that on type 2 diabetes, also massively increased. The rise in prescriptions for both these conditions accelerated rapidly during austerity but no connection was made and emphasis remained on personal action and responsibility. Nothing was said about either the food industry or big pharma.
I worked for several years teaching on a course for young young adults with mental health, and social and emotional difficulties. It wasn’t hard to see how the systemic pressures to conform and to suceed in very specific ways impacted on them. We were good at re integrating these students (often non attenders at school) into college life. The staff team were kind, nurturing, often providing support beyond the college day and tried to keep below the radar of college requirements on attendance and punctuality. We did good work but so much was sticking plasters. Eventually our course leader, a brilliant women, was made redundant and many of us followed.
So many people with “mental health problems” are just exhibiting a sane and understandable response to a very dysfunctional, antisocial, neoliberal society.
I feel so sad at their predicament.
I think this also feeds back into your post on what to do.
One big thing would be for the MSM to start making connexions between the economic/political landscape and the many problems it highlights as the problems of individuals.
Many thanks for this.
I saw the programme. I agree “Nothing was said about either the food industry or big pharma.” There ere still limits, but thanks for your comment.
You’ve focused on mental health but there is much to note in other branches of medicine such as clinical drug trials, where groups such as ethnic minorities, women and older people are often omitted or underrepresented, to favour efficacy but not real world effectiveness, and also regulatory capture by big pharma, where we see far too many ineffective and ‘me too’ drugs approved, with the main harm being billions of dollars generated as profit, and sometimes direct physical harm owing to side-effects.
There are also inequalities in care across the board, which favours the well off who are able to get better insurance and access to top teaching hospitals.
I agree with all that – including the drug trial issue, which is absurd.
You might like this
https://x.com/SamaHoole/status/2010209591024304244
Even if he beat you to it in terms of diet by 160 years…………..
🙂
Very good