Need feedback: Medicalization..raising awareness and potential study?

Long Term Care Columnist / Guide · Sep 21, 2013

I would definitely be interested in participating, should you decide to continue with your research on this topic. Personally, I'm all for anything that opens a dialogue and gets people to thinking. The fact that nurses in many states have to choose between lying about their mental illness on license applications and being placed in a long-term monitoring program for addicts/alcoholics, is proof that we are regarded as "guilty" before we ever make a med error or forget a piece of documentation. (And what nurse doesn't?)

It's just as bad when a nurse (like me) has been licensed for many years and picks up a psychiatric diagnosis between renewals. You probably had this problem for a long time before a doctor said "You have _____", and you're the same person you were before you got the label---now all of a sudden you're persona non grata and the BON wants to punish you for being mentally ill. Like you actually CHOOSE to get sick with something like bipolar or major depression.

Tell me, does a nurse with heart disease or diabetes or cancer have to pee in a cup in front of a stranger every week and call in to an automated voice messaging system every day, including Sundays? The nurse who is honest about reporting her/his mental illness does. Not only that, her/his board orders are often a matter of public record (HIPAA anyone??) and can be found by any member of the public with just a few mouse clicks. Great way to "help" nurses with psychiatric problems.....

OK, climbing down off my soapbox now. The point is, those of us who are affected by one or more of the so-called serious mental illnesses are marginalized and discriminated against, even though we supposedly have laws protecting us (don't even get me started on the Americans with Disabilities Act---the emperor has no clothes). And anything that calls public attention to these injustices would likely be of considerable benefit, maybe not for awhile but in the future.

Teresag_CNS · Sep 22, 2013

I am interested, but I'd like more explanation of what you mean by "medicalization." Thanks.

Laurie52 · Sep 22, 2013

I would definitely be interested in participating should you decide to continue with your research on this topic. Personally, I'm all for anything that opens a dialogue and gets people to thinking. The fact that nurses in many states have to choose between lying about their mental illness on license applications and being placed in a long-term monitoring program for addicts/alcoholics, is proof that we are regarded as "guilty" before we ever make a med error or forget a piece of documentation. (And what nurse doesn't?) It's just as bad when a nurse (like me) has been licensed for many years and picks up a psychiatric diagnosis between renewals. You probably had this problem for a long time before a doctor said "You have _____", and you're the same person you were before you got the label---now all of a sudden you're persona non grata and the BON wants to punish you for being mentally ill. Like you actually CHOOSE to get sick with something like bipolar or major depression. Tell me, does a nurse with heart disease or diabetes or cancer have to pee in a cup in front of a stranger every week and call in to an automated voice messaging system every day, including Sundays? The nurse who is honest about reporting her/his mental illness does. Not only that, her/his board orders are often a matter of public record (HIPAA anyone??) and can be found by any member of the public with just a few mouse clicks. Great way to "help" nurses with psychiatric problems..... OK, climbing down off my soapbox now. The point is, those of us who are affected by one or more of the so-called serious mental illnesses are marginalized and discriminated against, even though we supposedly have laws protecting us (don't even get me started on the Americans with Disabilities Act---the emperor has no clothes). And anything that calls public attention to these injustices would likely be of considerable benefit, maybe not for awhile but in the future.[/quote']
Are you saying that if you have a diagnosis of depression you have to be placed in a monitoring program and submit urine samples?

Long Term Care Columnist / Guide · Sep 22, 2013

Are you saying that if you have a diagnosis of depression you have to be placed in a monitoring program and submit urine samples?

Technically, anyone with a mental disorder has to notify the BON of that fact. It's up to the Board to decide if the licensee needs to be in the monitoring program. TBH, I don't think they do that with nurses who have depression unless they've been hospitalized for it, because there wouldn't be anyone left to take care of the patients! It's mainly those with bipolar, schizophrenia, borderline PD and so on who are more apt to be placed in such programs.

elprup, BSN, RN · Sep 22, 2013

Wow, I had no idea those with a diagnosis had to inform the BON!? Wow is all I can say. I cannot imagine dealing with a mental health condition and the BON and the discrimination with everybody knowing.

Long Term Care Columnist / Guide · Sep 22, 2013

It's different in each state. Some don't even ask, while others want to know if you've been treated for ANY kind of mental illness in the past five years.

In my state, the wording of the question is ambiguous enough that if you squeeze around it well enough, you can sort of dodge it. It reads "Do you have any physical or mental condition which impairs, or may impair your ability to practice nursing safely?" Well, if you're stable and working, it doesn't impair you. But how can you quantify the second part of that question? Do you have a crystal ball that can predict whether or not you'll ever be impaired?

Me neither. I may end up going to Hell for it, but I said "No". I've done nothing to deserve the kind of humiliation these so-called "services" subject nurses to, and I'd rather give up my license than submit to it. But, that's just me.

medisec · Sep 22, 2013

Great question, but also complicated. Medicalizing disability has it's positive and negative connotations in relationship to social constructs. It's basic definition is not really negative, it just means to 1. view or treat as a medical concern, problem, or disorder those who seek to dispose of social problems by medicalizing them; 2. to view or treat as a medical concern, problem, or disorder (Webster).

However, I am still exploring how this applies to disability in particular nurses and nursing students with (who disclose) bipolar and mental health. I think an example woud be the monitoring program. From what I've read in this forum, nurses with bipolar for example are medicalized by the BON as "addicts" because they are required by the BON to be placed in a treatment program designed specifically for drug and alcohol addiction. ****Viva gives a better description below about how nurses with bipolar are marginalized by being subjected to monitoring***** So, if I apply this definition correctly... basically the BON is medicalizing disability in a negative way to avoid a potential risk. It is identifying (medicalizing) bipolar as a disease/disorder while assigning it a negative social contruct. I really could not find any justification academically or otherwise as to why nurses who disclose bipolar are placed in this program. Anyway, that is one way of looking at it. The following are more "formal" and historical and theorizing definitions...you can also Google the general term "medicalization." I think disclosure fits in here also, which also perpetuates perceptions of disease, marginalization, and stigma.

Here are some more complicated definitions of "medicalization" if that helps. Note the ones in asterisks, I think they might apply here:

>Medicalizing disability is defined as a disability in the medical model is defined as bodily malfunction, while the social model converts it from an individual physical problem to a social problem.

>Medicalization is a process whereby medical and health precepts have been embodied in individuals who assume this responsibility for themselves...

....a process by which nonmedical problems become defined and treated as medical problems, usually in terms of illnesses or disorders.

...a medical perspective played in the analysis of society and its ills

...biomedical outlook on the management of populations

...a medical perspective over individual rights

...the modern welfare state governs the bodies of people with sovereign rights. They also fail to appreciate there is an inverse relationship between the progress of the medicalization in the twentieth century and individual liberty--that a doctrine of the healthy citizen has displaced, in some degree, a regime of the citizen of rights.

*****....although doctors are always on the lookout for personal and professional reasons to medicalize a condition the treatment of which will increase their power or income, in the modern state they often as not act as experts in conflict resolution between private individuals and insurors or between individuals and state entities...medical opinion may have a bearing on matters ranging

from the ability to hold down a job, be a good parent, receive injury compensation, and a

host of other typical conflicts in the modern welfare state.

****...state's interventions in particular areas of life are brought under critical scrutiny in terms of

their legitimacy (do they encroach on the necessary freedoms of individuals?) and the competence

and cost-effectiveness of its methods (can the objectives be achieved without state

intervention: that is by members of society themselves?)"

In the twentieth century where the juridical institutions or procedures have

been liquidated or crippled, the doctrine of the healthy body has been transformed into a

justification for hygienic elimination of the weak and unfit, the medical sequestering of political

and civil deviants, and a thoroughgoing control of reproduction and women's bodies

(Kater, 1989; Proctor, 1988; Weindling, 1989).

medisec · Sep 22, 2013

Thanks Viva. I'll keep everyone and you posted if I move forward with the study. I need to go over the logistics with my advisor about creating a small study. However, I'm working with her on expanding this analysis/study while taking a medical rhetoric course this semester. We just finished a book by Judy Segal where the author touches on medicalization and medicalizing illness, not specifically mental health though. I'd also still like to hear from some other participants to get their thoughts.

Laurie52 · Sep 22, 2013

It's different in each state. Some don't even ask while others want to know if you've been treated for ANY kind of mental illness in the past five years. In my state, the wording of the question is ambiguous enough that if you squeeze around it well enough, you can sort of dodge it. It reads "Do you have any physical or mental condition which impairs, or may impair your ability to practice nursing safely?" Well, if you're stable and working, it doesn't impair you. But how can you quantify the second part of that question? Do you have a crystal ball that can predict whether or not you'll ever be impaired? Me neither. I may end up going to Hell for it, but I said "No". I've done nothing to deserve the kind of humiliation these so-called "services" subject nurses to, and I'd rather give up my license than submit to it. But, that's just me.[/quote']
This just doesn't seem putative or discriminatory to me. They are asking about either mental or physical illnesses. They are not asking you to foretell the future, they are asking if at this time, are there any issues. Why is this not reasonable? I was talking to an anesthiologist recently and he said that in our state that he had to undergo mandatory drug testing simply because the incidence of abuse is so high in this speciality. Any profession that holds the public trust is held to higher standards. If I had to undergo drug testing I wouldn't care. Inconvenient perhaps but seriously just a blip on my radar.
I realize that we have both had different life experiences, I'm not trying to be critical but just offering a different view.

LadyFree28, BSN, LPN, RN · Sep 22, 2013

This just doesn't seem putative or discriminatory to me. They are asking about either mental or physical illnesses. They are not asking you to foretell the future, they are asking if at this time, are there any issues. Why is this not reasonable? I was talking to an anesthiologist recently and he said that in our state that he had to undergo mandatory drug testing simply because the incidence of abuse is so high in this speciality. Any profession that holds the public trust is held to higher standards. If I had to undergo drug testing I wouldn't care. Inconvenient perhaps but seriously just a blip on my radar.
I realize that we have both had different life experiences, I'm not trying to be critical but just offering a different view.

Why does one who has a chronic mental health problem; is managing it successfully, have to undergo the SAME program as one who has a documented diversion problem; undergo drug testing, attend NA and AA for a mental health problem???

I didn't know that having a mental health illness equaled a substance abuse disorder. :blink:

That is unreasonable IMHO...it goes into the stereotype that most people with mental health issues abuse drugs; most of us are educated to utilize critical thinking and the nursing process; I would not have an issue with the BON making sure nurses with chronic mental health illness have access to counseling, and other factors to ensure success; but try are NOT doing that. :no:

That was Viva's point.

OP, I think it's valuable that you do this proposal; I look forward to hearing more about your plans. :yes:

medisec · Sep 27, 2013

So far I think I might get the to ahead to do the study, although it will take a while to get IRB approval through my university...maybe by the semester's end?? I will keep everyone posted, but I do appreciate the interest and hope to get some great feedback when I do get the green light.

In the meantime, I am focusing on the narrative analysis of some of the threads concerning this topic and how nurses diagnoses of "bipolar" are medicalized as "addicts" - which two of my professors thought was just mind boggling. One of them is a disability studies specialist in the field and he kept asking if that is legal, how that violates privacy, especially when a employer asks in your new hire paperwork disclosure of meds and mental health history. Is that when and where they determine you have to participate in a monitoring program? The available literature is very sketchy, mostly about actual "addicts."

Anyway, I did want to find out, and Viva I might have email you separate since you have been sharing detailed knowledge of this topic...

Is the monitoring at the discretion of individual hospitals, the state and/or a combination of that and the BON? I ask because it is very difficult to find specific information about this other than the BON website, which even there it says monitoring is voluntary?? and/or is it at the discretion of the hospitals' hiring policy as to how long a nurse with bipolar needs to go through such as program? and who pays for it? I hope to gain a little more insight, especially since most research in this field refer to older studies that include interviews and observations, nothing too recent.