Department of Physical Medicine and Rehabilitation, New York University, Rusk Institute of Rehabilitation Medicine, 400 E 34th St, New York, NY 10016 USA.
Harm Reduct J. 2012 Jan 18;9:4. doi: 10.1186/1477-7517-9-4.
The goal of this paper is to both understand and depathologize clinically significant mental distress related to criminalized contact with psychoactive biotic substances by employing a framework known as critical political ecology of health and disease from the subdiscipline of medical geography. The political ecology of disease framework joins disease ecology with the power-calculus of political economy and calls for situating health-related phenomena in their broad social and economic context, demonstrating how large-scale global processes are at work at the local level, and giving due attention to historical analysis in understanding the relevant human-environment relations. Critical approaches to the political ecology of health and disease have the potential to incorporate ever-broadening social, political, economic, and cultural factors to challenge traditional causes, definitions, and sociomedical understandings of disease. Inspired by the patient-centered medical diagnosis critiques in medical geography, this paper will use a critical political ecology of disease approach to challenge certain prevailing sociomedical interpretations of disease, or more specifically, mental disorder, found in the field of substance abuse diagnostics and the related American punitive public policy regimes of substance abuse prevention and control, with regards to the use of biotic substances. It will do this by first critically interrogating the concept of "substances" and grounding them in an ecological context, reviewing the history of both the development of modern substance control laws and modern substance abuse diagnostics, and understanding the biogeographic dimensions of such approaches. It closes with proposing a non-criminalizing public health approach for regulating human close contact with psychoactive substances using the example of cannabis use.
本文旨在通过运用医学地理学子学科中的健康与疾病的批判政治生态学框架，理解并消除与受刑事处罚的精神活性生物物质接触相关的具有临床意义的精神困扰，并将其病理化。疾病的政治生态学框架将疾病生态学与政治经济学的权力计算结合起来，要求将与健康相关的现象置于其广泛的社会和经济背景中，展示大规模的全球进程如何在地方层面发挥作用，并在理解相关的人类与环境关系时，适当关注历史分析。健康与疾病的批判政治生态学方法有可能纳入越来越广泛的社会、政治、经济和文化因素，以挑战传统的疾病病因、定义和社会医学理解。受医学地理学中以患者为中心的医学诊断批判的启发，本文将采用批判的疾病政治生态学方法，对物质滥用诊断领域以及相关的美国物质滥用预防和控制惩罚性公共政策领域中发现的某些流行的社会医学对疾病的解释，特别是对精神障碍的解释提出质疑，因为这些解释涉及到生物物质的使用。本文首先批判性地审查了“物质”的概念，并将其置于生态背景下，回顾了现代物质控制法和现代物质滥用诊断法的发展历史，并理解了这些方法的生物地理维度。最后，本文以大麻使用为例，提出了一种非刑事化的公共卫生方法，用于规范人类与精神活性物质的密切接触。
