I have always wondered about medical science’s propensity to dehumanise patients.
People are seen as a set of symptoms. The cause of symptoms are seen as either genetic or environmental. The bias is a biological one.
In our current model of medicine, surely the craziest dichotomy is between physical health and mental health. Mental health, of course, has a psychological bias.
These biases have everything to do with origins and professional jealousy, and nothing to do with life as most of us experience it.
Progress is being made towards seeing the patient as a human being. I watched a short video last year on Shared Decision Making in which a doctor (a General Practitioner) actually talked to one of his patients who was a frequent attender at surgery and at A and E. Instead of asking about symptoms, the doctor asked his patient about his life. It turned out that the patient’s wife was in a care home difficult to reach by public transport and he was missing her terribly. The practice put on a taxi service for him to visit his wife. His attendances at surgery and A & E stopped.
I have been reminded of this video over the past few days while reading Opening Up, a book by eminent psychologist James W. Pennebaker. In it, Pennebaker examines links between psychological inhibition and physical health. It’s a fascinating read. If nothing else, it shows our mind and body to be one system – which our professional science has, in its cartesian dualist way, split into two. The way medicine denigrates illness when it identifies a psychosomatic origin is evidence of its dualistic bias.
Freud was one of the first to identify trauma and its suppression as a cause of illness later in life. Pennebaker, being a scientist, has actually gathered evidence that points in the same direction. As you might expect, there is far more nuance in Pennebaker’s work than in Freud’s Grand Theory approach, but one of his discoveries is so remarkably simple I am quite at a loss why it is not being universally applied.
The discovery is this: For many people, illness in later life is linked to a trauma in earlier life – a trauma to which they have not been able to give expression. Sexual abuse inside a family, because of the associated taboos, is a good example.
Being able to talk or write about a trauma without fear of being judged, of not being believed (see previous post), or of suffering some social penalty helps bring something deep to the surface. The simple act of expressing what happened and what they feel about it acts as a purge. The individual is able to adjust and get on with their lives and be healthier.
Pennebaker has also examined the efficacy of writing/talking cures relating to recent trauma. So, for example, you have just been diagnosed with breast cancer. Patients who are able to express their feelings about it tend to recover better and quicker than those who inhibit their response.
The British NHS is obsessing now about better outcomes for patients. What that means when translated is: doctors and nurses need to work harder and smarter.
So here’s my suggestion. Why doesn’t every hospital and GP practice pay someone to either listen to patients’ life stories or facilitate their writing about a trauma, past or present. A pilot project with a control group would help to identify the cost-benefits. My bet is that it would be cheaper than employing a doctor and the outcomes would be better. Furthermore, the number of people presenting for care would be greatly reduced thus representing a saving to the health system as a whole.