Biomedical Engineering Reference
In-Depth Information
rather than on disease criteria.
16
What should be counted as a too high blood
pressure, calling for diagnosis and treatment, ultimately rests on a clinical
judgment related to the individual person whose body is being investigated
(Svenaeus 2001). What is too high for me could be all right for you, within
certain limits. One should be aware that the reason why the domain of the
normal is getting narrower every day, is not only that doctors and scientists
come to learn more about diseases and become more able to treat them,
but also that the companies who manufacture and sell pharmaceutics have
a clear interest in pushing the borderlines of what should be treated (Healy
2004). Doctors not only treat a state of the body because it
is
a disease, it
becomes
a disease because it can be treated (Elliott 2003).
We should probably talk more about illness in its own right, instead of
constantly slipping into disease-talk. In a way that is exactly what I have
been trying to do in the case of Prozac by introducing phenomenology. It
is very seductive to talk about serotonin instead of talking about human
misery (for doctors as well as patients, not to mention politicians and the
representatives of the pharmaceutical companies), but it is not going to get
us the whole way, nor even very far, in understanding and helping persons
who suffer (Crossley 2003). Do not get me wrong here; I am convinced
that SSRIs have helped thousands and thousands of people, who could
not have been helped in any other existing way. The phenomenological
notion of “bodily resonance” fi ts well into explaining why the serotonin
level could be very important to feelings and being-in-the-world. But
our biology needs to be put into this very phenomenological pattern of
meaning-constitution, lest we should mystify it and make it into something
totally foreign to problems of everyday life. Serotonin talk encourages
us to blame our brains rather than our selves and the society we live in
(Valenstein 1998). “It is not me who is ill, it is my body”. In one way
this view on depression (and anxiety disorders) gets it exactly right. The
depressed person experiences an
alien
quality, which is present at the heart
of her existence and being-in-the-world - the lived body. But this lived
body is certainly also
herself
, and not a mere thing.
The ways of the body (biological as well as lived) are not only changed
by drugs and other physical infl uences, such as suffering a stroke, or burning
one's hand on the stove, for instance. They are also altered by the feelings and
thoughts we have in life. Being depressed might certainly be caused by low
serotonin, but this also works the other way around: being bored, sad and
anxious might cause the serotonin levels to go down. To raise the serotonin
levels in the synapses of the brain by way of an SSRI is a possible cure for
depression and anxiety disorders. But it should also be acknowledged that
the
belief
that one is raising the serotonin levels by way of an SSRI could
lead to relief from illness by itself. According to the Swedish Council on
Technology Assessment in Health Care, meta-studies of clinical trials have
shown that almost 50 per cent of the effect of SSRIs is placebo or natural
recovery (SBU 2004: 197). This is quite a powerful response; the confi dence