Introduction: medicine’s shadowside: revisiting clinical iatrogenesis

Abstract

Drawing on the work of Ivan Illich, our special issue reanimates iatrogenesis as a vital concept for the social sciences of medicine. It calls for medicine to expand its engagement of the injustices that unfold from clinical processes, practices, and protocols into patient lifeworlds and subjectivities beyond the clinic. The capacious view of iatrogenesis revealed by this special issue collection affords fuller and more heterogeneous insights on iatrogenesis that does not limit it to medical explanations alone, nor locate harm in singular points in time. These papers attend to iatrogenesis' immediate and lingering presences in socialities and structures within and beyond medicine, and the ways it reflects or reproduces the racism, sexism, and ableism built into medical logics.I want my voice to be harsh, I don't want it to be beautiful, I don't want it to be pure, I don't want it to have all dimensions. I want it to be torn through and through, I don't want it to be enticing, for I am speaking of man and his refusal, of the day-to-day rottenness of man, of his dreadful failure. I want you to tell.-Frantz Fanon, Letter to a Frenchman, Toward the African Revolution This special issue is dedicated to Leah M. Ashe (1980Ashe ( -2020. Shadowside medicineThis special issue grew out of our experiences as ethnographers of the clinic who witnessed a number of uncomfortable and distressing situations, which starkly limited our agency and capacities to theorize. One of us watched patients receive electroconvulsive therapy in psychiatric settings without anesthesia or sedatives, in contravention to Indian law and UN human rights guidelines (UN Human Rights Council 2013). The short-circuiting of law was justified as necessary in a resource-poor setting; some care, psychiatrists argued, was better than no care. Another of us was a bedside witness to the cumulative impacts of

Negotiating trust during times of uncertainty: haemophilia and AIDS

“…Health outcomes are better in societies where trust is high; but societal changes, such as those that occurred with AIDS and COVID-19, 80 led to disruption of trust in many parts of the world, raising new ethical imperatives for patients and physicians. Notably, beneficence of intent, notions of justice, and value-based decisions 78 Illich (1974) and Varley (2021). The limits and iatrogenic harm of the medical industrial complex were extended to contemporary issues in a series of articles introduced by Varley.…”

From iatrogenesis to vaccine skepticism: US mothers’ negative vaccine perceptions and non‐vaccination practices as reverberations of medical harm

“…In the following analysis, I consider vaccine skepticism to be one significant consequence of women's systemic harm at the hands of US healthcare from childhood through childbirth, one of the many “reverberating effects” of iatrogenesis “into patients’ life‐worlds and subjectivities beyond the clinic” (Varley and Varma, 2021, 143). Beyond individual cases of “bad doctoring,” as the term medical error might connote in common parlance , iatrogenesis refers to the deeply entrenched structural and endemic nature of medical harm in the context of institutionalized, for‐profit, and professionalized medicine.…”

“…In pointing to medical error as pervasive and systematic, such studies reveal the frequency with which US medical encounters result in injury, illness, or death—what Illich, and the large body of scholarship his work has since inspired, theorized as iatrogenesis (see, for example, the special issue devoted to clinical iatrogenesis, Varley and Varma, 2021). In an enterprise where the male, white, heterosexual, and nondisabled body has long been the basis of “biomedical citizenship,” belonging with regard to medical access and legibility (Sobo, 2021b, 208), iatrogenic harm flows disproportionately to women and underrepresented minorities.…”

“…While scholarship robustly documents the double burden of women's iatrogenesis and responsibility for children's health, what has been less considered is how iatrogenesis impacts women's enduring healthcare beliefs and behaviors. In analyzing this relationship, this article underscores the far‐reaching consequences of women's systematic medical harm, showing how iatrogenesis in the US provokes “lingering presences in socialities and structures within and beyond medicine” (Varley and Varma, 2021, 143).…”

Wound Culture

“…Medicine itself can often be the engine of wounding. Medicine can generate pain, and tracing these paths of cause and effect can deepen a political commitment to studying iatrogenesis (Greenhalgh 2001, Illich 1976, Owens 2017, Varley &Varma 2021. Clinical pursuits often foreground the degree to which people who pursue therapy can actually live with medicine's splitting forces (Boyer 2019, Jain 2013).…”