In the strict lexicon of internal medicine, there is no such thing as punishment. Medicine, after all, is supposed to heal, not to discipline. Yet anyone who has spent time inside hospitals knows that care is not merely technical; it is moral. Patients are rewarded or sanctioned not only for their pathologies but for their behaviors. The so-called “non-compliant” patient—the one who skips doses, drinks despite cirrhosis, or refuses prescribed diets—often finds access to resources narrowed. A transplant board will withhold a liver from an alcoholic who has not demonstrated abstinence; a dialysis unit will discharge a patient who persistently abuses staff. These are not framed as punishments, but as clinical necessities. Still, the patient experiences them as punitive, as consequences tied not only to disease but to conduct. Here emerges what could be called paramedical punishment: measures justified in therapeutic language, yet operating with the logic of discipline.
The grounds for such punishment are various. Medical infractions involve failures to adhere to treatment. Behavioral infractions are breaches of etiquette or civility in the hospital—aggression, manipulation, refusal to engage. Clinical infractions lie in a grey zone: exaggerating symptoms, sabotaging recovery, self-harming in ways that undo therapeutic effort. In all cases, a moralizing dichotomy emerges: the “good patient,” who is compliant and docile, versus the “bad patient,” who resists, disrupts, or deceives. The good patient is rewarded with more trust, more access, perhaps even more sympathy. The bad patient finds doors closing, sometimes without those closures being named as punishment.
This logic is not confined to medicine. In the world of psychological support and coaching, ostensibly far from hospital walls, similar dynamics unfold. The language shifts—there is talk of growth, resilience, and boundaries—but the structure remains. Coaches may respond to non-compliance by withholding attention, assigning remedial exercises, or subtly framing resistance as a personal failure. Psychotherapists sometimes end treatment, not always because of clinical hopelessness, but because the patient has repeatedly violated implicit rules. These practices are justified in the idiom of care, but they work as sanctions, operating in the grey zone between therapy and discipline.
A further extension is visible in professional environments, particularly in IT sectors governed by agile and scrum methodologies. Here the setting is not a clinic but a workplace; nevertheless, the same dialectic of infractions and punishments reappears. The “infractions” are lateness to stand-ups, failure to complete sprint tasks, or reluctance to conform to the rituals of collaboration. The “punishments” are often informal: reputational damage, exclusion from decision-making, reassignment to less prestigious roles. What is striking is the rhetorical frame: these measures are not described as penalties but as feedback, as tools for collective improvement. The system promises empowerment, yet it disciplines in ways that can be as sharp as any clinical sanction.
Across these domains—medicine, psychology, coaching, and management—we see a shared logic. Supportive languages conceal disciplinary practices. Patients and workers alike are held responsible not only for outcomes but for attitudes. Infractions, whether medical, behavioral, or professional, invite consequences that are explained as protective or therapeutic but felt as punitive. This is the paradox of disciplinary care: its sanctions are justified as being “for your own good” or “for the good of the group.”
The genealogical threads are clear. Michel Foucault described the rise of biopolitics, the transformation of medicine and psychology into apparatuses not merely for curing disease but for governing conduct. The hospital, the clinic, the coaching session, the scrum meeting—all can become sites where the language of healing or productivity masks the reality of discipline. What binds them together is the expectation of docility: the compliant body, the responsible mind, the agile worker. Those who fall outside these norms encounter paramedical punishment, whether in the form of denied transplants, terminated therapy, or subtle exclusion from professional communities.
The question, then, is not only how to describe these structures but how to live within them. For patients and professionals alike, navigation requires recognizing the dual nature of care: that it heals, but also that it disciplines. Resistance may be possible, but it must grapple with systems that have learned to hide punishment inside the language of protection.
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