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Lex maniac

Investigating changes in American English vocabulary over the last 50 years


(1980’s | doctorese? therapese? | “be your own doctor”)

From new expression to casus belli. Armies of people self-medicate (actually, we all do at least some of the time), and such practices are generally discouraged, particularly in the case of mental or emotional distress. While self-medication might involve a very wide range of substances, in practice it is generally brought up with reference to alcohol and popular recreational drugs. In some quarters it is assumed that regular use of intoxicants must mean that a person is dealing with some kind of mental health lapse. “Self-medicate” occurs with extraordinary frequency in discussions of addiction; the connection between drug addiction and (undiagnosed) mental illness is all but tautologous — you only get hooked if you have a problem. I’m sure that is often true, but there are exceptions. And of course, addiction may arise from physical pain as well as mental. Self-medicators don’t use only drugs; overeating is a common villain in this story, and other indulgences may qualify.

Google Books coughs up a couple of examples of the phrase pre-1970, but it didn’t start coming into its own until the late seventies. “Self-medicate” is not an idiom in the sense that there’s anything counterintuitive about it; the two components are readily available and easily combined, and the first time you heard it you wouldn’t know it was a fixed phrase. The OED dates “medicate” back to the seventeenth century, but the citations show that at first it more likely meant “cure” or perhaps “infuse (an object) with medicine,” but not “treat (a person) with medicine” until the late nineteenth century. The word “medication” (now often simply “meds”) did not take off until after the war, when everybody started popping pills. Thus “self-medicate” as we know it today probably could have burgeoned only in the twentieth century.

Because health care providers almost always disapprove of self-medication, it has taken on a transgressive, rebellious quality — not so much a sign of foolishness as independence, or a refusal to cede the power to make decisions for yourself. The libertarian counter-narrative has a certain appeal. Truth is, the doctor doesn’t want you to come in every time you have the sniffles; minor ailments can be handled just as well with over-the-counter remedies. But if it’s the least bit serious, you’d better get down to the office. And bring your insurance card with you.

Obviously, the medical profession has a lot at stake and wishes to maintain a monopoly over patients’ life-and-death decisions, and the less grave ones as well. Self-medication is deprecated partly because it threatens that monopoly. They want us to use their high-priced fancy drugs that put money in their pockets all up and down the line. There is another side to the case, of course. Those fancy drugs have been tested and looked at carefully by a lot of experts (that’s called regulation, people — and we need lots of it), so their failures and side effects are known. Home remedies and nostrums may do all sorts of damage without doing any good, and doctors have a duty to warn us of that. Doctors are bound by the Hippocratic Oath — though pharmaceutical and insurance executives are not — and so must advise against doing ourselves harm. It’s tempting to regard the prescription regime simply as a way to keep us in thrall to the medical establishment, but like most things, it’s not that simple.

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