The write way to better health

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.


The importance of being believed

The late celebrity Jimmy Savile is thought to have abused or raped more than 200 people, many of them children, over decades.

As his star crashed to earth, many of his victims  were able to come forward and tell their stories for the first time – stories they had locked away inside themselves, unable to find an ear that would listen to them and, more importantly, believe them.

This need to be believed and the consequences of not being believed are the focus of this week’s Blog.

A big question in the Jimmy Savile case is: How did he get away with it for so long? How could he abuse so many people and not be brought to justice in his lifetime?

This raises, for me, other questions: What is it about the distribution of power in our society that affects the nature of truth? How can we ensure that our institutions and the people who work in them are conscious of the bias inherent in the distribution of power and are able to take account of it so that the powerless are not disadvantaged?

The victims often explained their inability to accuse Savile by their fear that they would not be believed. Even when some could no longer keep their secret to themselves and had to tell someone ‘in authority’ they were not believed.Here’s a representative example, taken from a BBC interview:

Another of Savile’s victims, raped as a young girl in 1970, has revealed how she also summoned up the nerve to tell police what had happened. But nothing ever came of it.

“They were not very interested really,” the woman (who asked to remain anonymous) told the BBC. “I didn’t feel I was really believed. It has sort of haunted me quite literally. It has depressed me. It has made me feel disgusted with myself.”

It is part of the human condition to glorify certain individuals, to put them above the rest, to make them heroic. Once we put them there we have a tendency to want to keep them there. We make allowances for their foibles (or ignore them); we invest them with superhuman-ness based on their culturally significant gifts (whether it is the ability to win battles or to sing a moving love-song); and we project our own hopes and fears on to them. Our society continually reinforces this ‘halo effect’. Young people are told to find role models. The media feeds us a diet of celebrity trivia made meaningful only because it relates to someone we see on our TV or cinema screens. Football fans where team shirts with their player-hero’s name on it while they’re out shopping.

Television in particular is in the game of making celebrities – they are the currency of television. The BBC made Savile and having made him became enslaved to him – a bit like Frankenstein and his monster.

With such glorification comes power: Power to earn, power to indulge, power to command, power to abuse. Savile had power. It was both his shield and his weapon. He used it to conceal and deceive. He used it conspiratorially to bring those who could hurt him (the police in particular) into his orbit of influence. He was a star, a god.

His victims, on the other hand, were innocents unwittingly introduced to the altar of Savile’s sexual peccadilloes. The psychological harm they suffered by the need to keep secret what he did to them was worse than any physical harm he may have done them.

The negative impact on health from unspeakable trauma is well documented. See James W Pennebaker’s book Opening Up.

While Savile was alive and in his pomp, his halo protected him. His victims had to suffer in silence. Society and its institutions didn’t want to know. Being traumatised and your trauma not being believed has left more than 200 people damaged.

My suspicion is that another Savile will emerge unless as humans we learn to think better and understand, examine and act on our psychological biases.