Is there a diagnosis market?

The term market has been monopolized by the economic system. Steffen Roth, in “Market therapy? On intervention in the consociation with non-members,” writes:

the form we commonly observe as the market is only its economic dimension, to which, however, at least nine further dimensions can be added.

I want to take up that statement and ask how markets may be observed by politics, law, art, education, science, mass media, health, religion, and sport? These are the other nine dimensions (or function systems) Roth is referring to.

In an abstract sense, we might call a market a context for making selections. There is an environmental excess and a selection must be made. Complexity must be reduced through selection–selective couplings with the environment. Complexity

On complexity, Vladislav Valentinov writes,

According to Luhmann, the basic rationale for the existence of social systems is the reduction of complexity, which is understood as the infinite horizon of possibilities of action and experience (cf. Schneider, 2009, p. 251). This horizon is immensely complex. Human action implies an actualization of some of the possibilities out of
this horizon and is in this sense necessarily contingent.

All systems must engage in selection, so the market concept might be applied to all kinds of systems. There is no reason to focus exclusively on human selections because social systems also make selections. Environments provide variety, and systems select from this variety. We can think of variety as the horizon of possibilities.

The “purpose” of the economy may be said to be distribution of scarce resources, or maybe to solve the problem of scarcity so that everyone has “enough” of what they need to live comfortably. But these instrumental goals are created/observed by some other system, such as politics or some kind of moral system or organization; they aren’t the goals of the economy because the economy has no instrumental goals; it just has non-teleological operations.

The economy emerged to solve a societal problem, which was that isolated segmented societies (tribes) could not produce everything they needed or desired–in other words, scarcity. Segmented social groups needed to trade with other segmented social groups, and this trade occurred in a non-man’s land between tribal  territories. These places evolved into markets.

Money evolved to solve the limitations of the barter economy. The money economy circulates payments. Money allows the crossing of the boundary between non-payment and payment. The economic system identifies the moment when the boundary between payment and non-payment is crossed.

What counts as a market in the other function systems? This is a huge question, so we have to start with just one system. We can begin arbitrarily and look at the health (a.k.a., healthcare or medical) system. The healthcare system is not a network of hospitals, clinics, physicians and nurses, etc. It is an autopoietic communication system with a symbolically generalized communication medium.

What is the symbolically generalized communication medium for the healthcare system? Illness, which is marked by diagnosis and becomes the target of therapy or treatment. (Diagnosis and therapy may be placed under the headings of programme and function.) Non-illness does not mean health; it just the negation of illness. Illness is not a thing-in-itself; it is a difference. The same may said of the healthcare system.


Every symbolic communication medium is a two-sided form, and we can write the healthcare form as illness/non-illness. Patients cross the line between illness and non-illness, and that boundary must be crossable for the healthcare system to take notice. If a patient is terminal, and thus cannot recross the boundary to non-illness, the healthcare system loses interest and offers only palliative care. As such, patients are constructed by the healthcare system. One can only be identified as a patient by the healthcare system. A politician, teacher, etc., cannot diagnose or treat illness.

If we speak of a diagnosis market, the doctor (or the healthcare system itself) make a selection from the variety of possible diagnoses. The more possibilities there are, the longer the selection takes and the greater the potential for making the “wrong selection” or being dissatisfied with the selection. This happens to consumers who face a huge variety or commodities to choose from–a hundred different kinds of running shoe, for instance. In healthcare, the selection of diagnosis is always contingent–a different diagnosis could always be selected.

The healthcare system continually constructs (or observes) illnesses that it can treat. Every time a patient receives a diagnosis, that is an observation by the healthcare system. That is to say, the system makes its illness/non-illness distinction, and in this way reproduces itself as a social system. The system also observes new illnesses, that is, makes new diagnoses. These are new programmes. Programs are flexible and changeable, while the illness/non-illness form is stable. Thus diagnoses are formed and discarded over the years and centuries, as are new treatments. Diagnosis is a conditional programme, i.e., an If . . . program. “If the patient presents with symptoms X and Y, the diagnosis is Z.”

The invention of new diagnoses (programmes) represents a response to the increasing complexity of the system’s environment. In an increasingly complex world society, a healthcare system that cannot continue to make new diagnoses will succumb to entropy–that is, dissolve into its environment. Thus, conditions that in the past were just considered part of human life and not even given a name are identified and given names (e.g., Alzheimer’s disease, major depression, obsessive-compulsive disorder, PMS, erectile dysfunction, restless leg syndrome, insomnia, low testosterone); they are classified as treatable illnesses in order to give the health system something to work on.

Crossing is conditioned, meaning obstacles are erected to discourage crossing the boundary. An If must be met before a Then can be pronounced. Or we might say there is a lot of friction produced by trying to cross over. If this weren’t the case, the healthcare system would be overwhelmed with new diagnoses–just about anything could be considered an illness. It would also be too easy to cross from non-illness to illness and back again. Several conditions (several If’s) often have to met before a diagnosis is made

The diagnosis sets everything in motion. So we can ask, Is there a diagnosis market? How has the  variety of diagnoses increased? If we focus only on cancer, how many new ways types of cancer have been identified over the past 50 years? And is there a treatment market? How many new ways are there to treat a particular kind of cancer? If we are talking about markets, there has to be a scarcity or sense of limits. If every human experience is diagnosable as an illness, the system would overburden itself, it would suffer from information overload.




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