Medicalizing meaning: demoralization syndrome and the desire to die.
OBJECTIVE
To critically analyse the proposed new psychiatric condition, demoralization syndrome, and the implications drawn by its proponents for the clinical-ethical status of requests by terminally ill patients for assistance to die.


METHODS
The diagnostic features of demoralization syndrome, a proposed new psychiatric disorder, recognizable particularly in palliative care settings, are summarized. The consequences of proposed therapeutic interventions are described, one of which is relief of the desperation which motivates some demoralized patients to consider ending their lives and to seek assistance in dying. The connections between the proposed condition and the desire to die are analysed in the context of the continuing tensions surrounding the ontological status and sociopolitical implications of psychiatric categories and the pervasive medicalization of modern life.


RESULTS
The analysis suggests that by medicalizing existential cognitions at the end of life, the proposed diagnostic category also normalizes a particular moral view concerning assistance in dying.


CONCLUSIONS
While further research into the issues described in this provisional syndrome may benefit some patients, the categorization of demoralization as a medical diagnosis is a questionable extension of psychiatry's influence, which could serve particular social, political and cultural views concerning the end of life.
Parker
Malcolm
M
School of Medicine, University of Queensland, Brisbane, Queensland 4006, Australia. m.parker@uq.edu.au
D000928:Antidepressive Agents / Q000627:therapeutic use*; D001293:Attitude to Death; D003863:Depression / Q000188:drug therapy* / Q000523:psychology; D004363:Drug Utilization; D005065:Euthanasia / Q000941:ethics / Q000523:psychology*; D006801:Humans; D009042:Motivation
D000928:Antidepressive Agents