Medicalization and the pharmaceutical industry

Medicalization and the pharmaceutical industry form a recurring subject in the novel’s account of Rose Papastergiadis’s unexplained impairment and Sofia Papastergiadis’s long effort to understand it. Symptoms are repeatedly examined, named, and treated, yet no single explanation resolves Rose’s changing complaints. The contrast between clinical uncertainty and commercial certainty makes the treatment of illness a question not only of what medicine can do, but also of who gets to describe a problem and define its remedy.

Symptoms, stories, and the search for an explanation

Sofia’s investigation began in childhood and has continued for roughly twenty years. At four, she asked Rose what a headache meant; Rose described it through the image of a door slamming in her head. Sofia later treats this exchange as the beginning of a form of intimate observation: she has learned to read her mother’s symptoms closely, at times experiencing Rose’s head as if it were her own. The image expresses care, but also the extent to which Rose’s illness has occupied Sofia’s attention.

That attention takes on the structure of an inquiry. Sofia imagines herself as an unwilling detective trying to establish whether an illness without a clear explanation can be understood as an unsolved case, and she wonders how an anthropologist might interpret the triggers and meanings of pain. Her investigations repeatedly approach what seems like a discovery, only for Rose to present another unfamiliar symptom and receive another unfamiliar medication. The cycle makes medical explanation provisional: each new prescription responds to a complaint without necessarily connecting it to the preceding ones.

At the Gómez Clinic, the difficulty of constructing a coherent account becomes explicit. Rose’s history of present illness moves between current symptoms, earlier periods, and childhood rather than unfolding in chronological order. Julieta Gómez Peña listens with the intention of later transcribing Rose’s account and producing a case history. Sofia recognizes the parallel with ethnographic work, but also notices the mismatch between a clinical form built around a presenting complaint and Rose’s numerous complaints, which cannot be reduced to one or even a small set. In this telling, the past, present, and future of illness coexist in the same account; the record-making process organizes symptoms without making their cause certain.

Clinical care and the work of medication

The novel presents medical intervention as specific and consequential, not merely as an abstract symbol of institutional power. During an examination, Dr Gómez asks Rose to leave her shoes in place while he checks the sole of her right foot. He finds two ulcers, asks whether she has been tested for diabetes, and identifies a small, slightly infected surface area that requires immediate attention. This episode shows a clinician responding to a concrete finding even as Rose’s broader condition remains unexplained.

Dr Gómez also asks Rose to review her medications by identifying which ones she feels most attached to and which she can relinquish. His approach treats medication as both a clinical decision and a personal routine. Later, he tells Sofia that she has become accustomed to administering Rose’s medication and suggests that the practice has functioned as a ritual for both of them. He frames Sofia’s reliance on that caregiving role as a way of avoiding the question of how to make a life beyond it, and says that a different routine will have to take its place. His intervention therefore concerns the effects of treatment on the caregiver as well as the patient.

Rose experiences the period without medication as a difficult interval of waiting. She watches the still-working watch on her wrist, tears soft white bread into small pellets, and sucks them for hours. The pellets resemble her pills and offer some comfort while she waits for new pain to appear. She says that she is waiting for something to happen, and later reports that her pain is magnifying even though her feet are numb. These details make the removal of medication a lived change in daily routine, not simply a decision recorded by a clinician.

The novel does not present withdrawal from medication as a final or uncontested resolution. Rose asks Sofia to buy painkillers at a Spanish pharmacy, saying that a prescription is not required there; Sofia refuses. At a later review meeting, Rose says she is back on track with medication after a hospital doctor in Almería was concerned about her condition. Dr Gómez explains that Rose had been dehydrated and treated with intravenous saline, and that difficulty swallowing water also makes it difficult for her to swallow medication. The sequence shows treatment changing again as circumstances and medical advice change; it does not establish that either stopping or restarting medication has settled the underlying problem.

Commercial claims and the making of disorders

Dr Gómez describes the pharmaceutical representative’s business strategy as beginning with the creation of a disease category and proceeding to the offer of a cure. To illustrate, he asks Sofia to imagine an introverted person who is shy and wants to become bolder and better able to protect herself in everyday life. A company could recast those traits as social-anxiety disorder and market a medication for the condition it has defined. His example questions the boundary between ordinary variation and disease, and draws attention to the commercial interest involved in deciding where that boundary lies.

The encounter is presented through a particular scene of professional hospitality and unease. Dr Gómez thanks a nurse for bringing breakfast, instructs her to tell the next patient that he is running late, and raises the matter of the company visitor with Sofia. He leaves his orange juice untouched while explaining the representative’s interest in expanding the market. The conversation gives Sofia a view of commercial pressure as something that reaches into clinical work over time: the representative has, Dr Gómez says, been harassing him for years. The physician argues for intellectual independence from pharmaceutical solutions, but his explanation does not erase Rose’s need for care or the uncertainty surrounding her illness.

That uncertainty is sharpened when Rose seeks information about a newly prescribed pill from a representative at the review meeting. He explains that a doctor in Almería, whom he calls a colleague, prescribed it to quiet harmful internal conversations, including self-blaming or persecutory ones. When Rose checks what the medicine is supposed to do, the representative refines his description from erasing those thoughts to quieting them; another attendee offers hushes as a more natural English equivalent. The exchange reveals how treatment is communicated through reassuring language, and how a patient must interpret both the purpose of a medication and the confidence with which its effects are described.

Austerity, exchange, and the limits of the metaphor

The book places medication beside the language of economic reform. In a conversation with Sofia, Alexandra describes herself as conservative and compares accepting reforms with taking medicine. She links remaining on medication to remaining in the eurozone, while reporting that Christos Papastergiadis has moved most of his money from a bank in Greece to a British bank because the family does not know what will happen. The comparison connects individual treatment to a wider political argument about austerity, but it does not make the two situations identical: the parallel lies in the language of necessity, risk, and continued dependence on a prescribed remedy.

The financial stakes of Rose’s treatment are also concrete. Sofia says the family remortgaged Rose’s house to pay for care at the Gómez Clinic, at a total cost of twenty-five thousand euros. That expense sits alongside Sofia’s long-running attempt to interpret her mother’s symptoms and the succession of treatments that has not yielded a decisive explanation. The cost makes clear that medicalization is not only a matter of terminology or pharmaceutical marketing; treatment also rearranges family resources and intensifies the practical burden of caregiving.

Narrative significance

The competing accounts of illness are never simply interchangeable. Rose describes pain and numbness from within her daily experience; Dr Gómez examines particular symptoms while acknowledging that chronic pain has not yielded its explanation; Julieta Gómez Peña listens and prepares a case history; Sofia interprets the accounts as both daughter and ethnographer; and the pharmaceutical representative presents a medication through the language of its intended effect. Each account makes some aspects of Rose’s condition more legible while leaving others unresolved.

The novel’s attention to narrative form reinforces that limit. Rose’s history does not arrive in orderly clinical sequence, and Sofia, present at the consultation, admits that she is not listening as she watches a David Bowie concert on her laptop. The gap between the patient’s account, the clinician’s record, and the caregiver’s attention becomes part of the story of treatment itself. Medicalization and the pharmaceutical industry matter here because they offer frameworks for naming and acting on illness, but the narrative withholds the assurance that naming, prescribing, or recording a symptom is the same as understanding it.