醫療化、醫權政治與治療型國家：一個策略－關係取向的批判

Medicalization, Pharmacracy, and the Therapeutic State: A Strategic-Relational Critique

在醫療化作為社會控制形式的文獻中，國家的角色很少獲得恰當的重視，少數的例外是將國家當成醫療化主要行動者的治療型國家理論。作者認為，Szasz 的理論除了提供以社會為中心的取向外，亦提出以國家為切入點來探索醫療、國家與當代資本主義關係的可能性。然而，由於對醫療化採取過於狹隘的概念定位、忽略醫療市場的特殊性，並無視醫療產業複合體對醫療照護體系的支配，Szasz 的理論完全脫離資本主義社會的現實脈絡。本文從策略－關係取向出發，藉由醫權政治即國家形式、治療型國家即政治策略，以及醫療化即社會成型這三個層次的脈絡化，檢視Szasz的治療型國家與醫權政治。

In literatures of medicalization as social control, the role of the state either is ignored or is an uncritical imitation of imported theoretical model, with few exceptions such as theories of the therapeutic state. In perspective of the strategic-relational approach, this paper examines the potential and limitation of Thomas Szasz's theory of the therapeutic state. Szasz's theory inspires a state-centred approach alternative to society-centred approach in understanding the relationships among the modern State, medicine, and capitalism. However, Szasz's theory has been seriously decontextualized from modern capitalist society to the extent that he adopts a narrow conceptualizing of medicalization, ignores the distinctiveness of medical care market, and disregards the dominance of the medical-industrial complex in the medical care system. Writing from a strategic-relational approach, this paper tries to reformulates Szasz's theory by recontextualizing therapeutic state and pharmacracy in capitalist society with pharmacracy as state form, therapeutic state as political strategy, and medicalization as societalization.