Anticipation and Medicine: A Critical Analysis of the Science, Praxis and Perversion of Evidence Based Healthcare (Concepts for Critical Psychology)

Anticipation in Medicine: A Critical Analysis of the Science, Praxis and Perversion of Evidence Based Healthcare looks at an aspect of healthcare rarely addressed: how the capitalist interest in diagnosis and treatment impacts upon the patient and, by extension, the system of healthcare itself. Using Lacanian structures of discourse, Dr. Owen Dempsey critiques the praxis of scientific Evidence Based Medicine (EBM) applied to anticipatory and preventive healthcare under capitalism and ultimately, what constitutes good care. This book features up-to-date case studies that combine real-life patients and the psychological impacts of anticipatory care such as cancer screening in the modern era. The book identifies the dangers of anticipatory care in medicine and provides compelling and new possibilities for progressing towards a more emancipatory conception of a less knowing, less apparently compassionate, as well as less harmful practice of health care. This is fascinating reading for academics, students and practitioners interested in critical health psychology, the practice of 'scientific' medicine, and the politics of health and social care Anticipation and Medicine- Front Cover Anticipation and Medicine Title Page Copyright Page Dedication Contents Preface Acknowledgments Introduction Chapter 1: The care paradox Introduction The regulation, appraisal and implementation of new forms of care and diagnosis The anticipatory care paradox Collateral harms Overdiagnosis Securitisation Absolute, normative, health Care without borders Qualified health Doing the good What is anticipatory care? Two modes of cure Presence to suffering Notes Chapter 2: Science and politics Introduction Evidence Based Medicine Logical empiricism (or logical positivism) Positivism and healthcare Healthcare and social norms Science and politics: a turn from the left to the right Subjective pragmatism and radical empiricism Social democratic logical empiricism and neoliberal pragmatism Notes Chapter 3: Science and politics – a case history: breast cancer screening Introduction Background to the breast cancer screening controversy The decision to continue screening and neoliberal pragmatism Note Chapter 4: Language, harm and overdiagnosis – a case history: the real cancer paradox Introduction Recap Altering the meaning of overdiagnosis and shaping public opinion Overdiagnosis Making meaning non-conscious or ungraspable Altering the meaning of diagnostic names and public opinion The real cancer paradox Notes Chapter 5: Politics and consciousness Introduction Scientific-political-economic philosophy Alienation and commodity fetishism Agency and decision-making Anticipatory care, agency, alienation and commodity fetishism Marx’s theory of labour power, alienation and commodity fetishism Ownership of the means of production The employment exchange Production phase Product exchange Innovation and the anticipatory care paradox Notes Chapter 6: Subjectivity, care-labour and Lacan’s structures of discourse Introduction Lacan’s structures of discourse The university discourse Institutional knowledge, persuasive rhetoric and commodity fetishism The institutional discourse and knowledge The individual’s discourse, care-labour and care-consumer The mirror stage and alienating identity Anticipation and alienation Note Chapter 7: Subjectivities of care – a case history: alienating identities Introduction Alienation Care-labour subjectivity and anticipatory care: a Lacanian discourse analysis The screener as care-identifier or diagnostician, entrapment of care-labour, and the master structure of discourse The cancer diagnosis as a product in exchange – the coercion to be a care-consumer Resistance, consciousness and the hysteric discourse The Graph of Desire and the subjectivity of the care-therapist Subjectivity The Graph of Desire Jouissance Fantasy Subjectivisation Castration Care-providers: an example of two contrasting subjectivities Perversion Notes Chapter 8: The opportunity costs of neoliberal pragmatist anticipatory care – a case history: a molecular genetic ‘signature’ for cancer risk Introduction The context and rationale for the development of Oncotype-DX The health technology appraisal process in the UK Opportunity costs The erosion of public healthcare services The threshold(s) for decisions to license new technology The ICER The InCEST (Incremental Cost and Effectiveness Sacrifice Threshold) taboo and sovereignty The InCEST (Incremental Cost and Effectiveness Sacrifice Threshold) taboo and sovereignty Innovation Oncotype-DX Chapter 9: Two impossibilities: burnout and the depersonalisation of care-giving Introduction Anticipatory care, the care-giving relationship and subjectivity The care-giving relationship and ‘doing the good’ The Ego-Ideal and the Ideal-Ego Burnout for inter-personal care-givers Anticipatory care removes love from care The unconditional demand Chapter 10: Neoliberal pragmatism incites perversion: the capitalist discourse Introduction From the perspective of the care-provider The destabilisation of the care-provider’s subjectivity by anticipatory care The weakening of the power of the Name of the Father Perversion Increasing self-referentiality The capitalist discourse Notes Chapter 11: The Oedipus complex and perverse care-provision: a case history Introduction Recap The Oedipus complex Forming a more or less stable subjectivity Sexuation and a relation to the Phallus Perversion and subjectivity Capitalism and perversion A case history Paradoxical care The care-provider and his actions Over-treatment Under-treatment Paterson’s Law Note Chapter 12: The biopolitics of anticipatory care: Spinoza and the prohibition of health Introduction Recap Epistemology and Spinoza Descartes’s circular argument Spinoza, Lacan, consciousness Anticipation as affect incites commodity fetishism The incest taboo and sovereignty The transition from the pre-capitalist to the capitalist era The pre-capitalist era The capitalist era Application to anticipatory care and the InCEST taboo Anticipatory care prohibits health Note Conclusion References Index This book critiques the way key normative conceptions of science in advanced capitalism both incite, and limit possibilities for, healthcare and render compassion itself prey to ideology. The author examines the concepts of health, knowing through science, and human subjectivity in relation to philosophical and psychoanalytic ideas.