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This chapter shows just how deep narrative runs in the daily medical world. It studies the central moral dimensions of medical practice, while noting that narrative seems to provide the place where difficult and disturbing moral issues can be raised. It introduces the notion of “narrative practices,” and stresses the point that the “medicalized object” is formed in narrative terms. The chapter also uses narrative in order to study the “temporal dimension of disease and the struggle to find coherent plots”.

Interviews with those who joined support groups and research studies reveal that persons with AD strategically employ the diagnostic label (or not) as they see fit. Study participants are not passive recipients of the disease label; rather they deliberately embark upon the path of becoming Alzheimer’s patients. Diagnosis causes increased tension over the management of self and others as individuals undergo considerable socialization into medicalized interpretations of their experiences. Most of the forgetful respondents in this study ultimately help accomplish the goal of modern medicine, as support groups and research studies model how to monitor and control both themselves and each other through a biomedical lens. Yet this involvement also allows participants to feel proactive in the face of memory impairment and normalize their often erratic behaviors and experiences. By placing hope in finding a cure and by participating in research, patients support and potentially shape biomedicine.

At various points throughout history, for reasons of plague, pestilence, and war, death has dominated human consciousness. This was especially apparent during the Bubonic Plague of the fourteenth century, which claimed the lives of up to two-thirds of Europeans. The Catholic Church responded by issuing texts, collectively known as the Ars moriendi, to guide the laity in its preparation for death. These books circulated widely throughout Europe, and were adopted and modified by both the religious and the non-religious, always with a view to preparing to die well. But as late nineteenth century Western society grew increasingly concerned with the art of living well, practices concerned with dying were largely forgotten or neglected, and death became medicalized. The field of bioethics has, since its earliest days, debated end-of-life issues, but it has not definitively aided the broader public in preparing for death. This book looks to bioethics to frame a modern Ars moriendi – one that can aid an aging, plural population to prepare for death and to support its members through the dying process.

This chapter studies the functions of disgust through the varieties of detachment that circulate through David Foster Wallace's Infinite Jest (1996). In this story world, detachment is not only a social and ethical problem; it is also an environmental one. Psychological and material practices of detachment underpin U.S. policies of environmental manipulation that poison bodies, and it also motivates the novel's major plots and distinguishes its style. Against detachment, the novel deploys disgust as an affective correlate to a medicalized environmental imagination. In detailing the functions of disgust in Infinite Jest, the chapter reconciles competing positions within affect theory on whether the feeling is attractive or repulsive. It is the dual aspect of pulling in and pushing away that makes this affect an unlikely hindrance to detachment, and the social and environmental injustices that it promotes.

This chapter begins with the story of Mr. Leroy Powell, a genuine addict whose criminal responsibility was addressed in a popular Supreme Court case in 1968. This story is presented to lay the groundwork for the issues addressed in this chapter. It is determined how and in what cases addiction affects criminal responsibility, after identifying the criteria for compulsion and the criteria for criminal responsibility. The question is also asked whether the law should adopt a medicalized view of addiction or not. It is also shown that the criteria for criminal responsibility, like that for addiction, are all behavioral, suggesting that any scientific information about addiction must be “translated” into the law’s psychological criteria.

The shift toward neurobiological imaginary in lay perspectives is the most general finding of the study, the pattern behind the other patterns of meaning. An “imaginary” is not a professional discourse or system of theoretical understandings, but largely tacit and socially shared meanings that animate and legitimate common practices and understandings. This chapter explores the most prominent indicators of the shift from a more psychological to a more medicalized viewpoint. The clearest indicator comes from participant prioritizing of brain states—for example, “chemical imbalance,” “misfiring brain circuitry”—as the effective cause of suffering. Even many people who did not refer to the brain directly spoke in terms that pointed toward a mechanistic, nonpersonal way of imagining the cause of their struggles. Another indicator, suggested by dismissive views of psychotherapy and presumptions of medication effectiveness, was a way of imagining suffering without temporality, social context, or meaning. The common thread was an approach to predicament resolution that comported with a strong view of self as self-defining. Other survey and time-trend studies of public and patient views toward questions of problem cause, medication, and psychotherapy have shown similar medicalizing views, and the chapter concludes with a brief review of these.

This chapter focuses on a long-term development in Western societies addressed as “privatized death,” namely, the assignment of the dying into hospitals and other institutions. This trend, mirrored in the works of French historian Philippe Ariès and psychologist Elisabeth Kübler-Ross, so the chapter argues, served as a “push factor” for articulating near-death experiences. Near-death experiences can be in part read as a “spiritual protest” against alienated, anonymous dying in institutions and the “materialist” take of modern biomedicine of merely prolonging life. This protest is also present in criticizing the “denial of death.”