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Absolute health and lack of it: Both Utopia
- Soumitra Shankar Datta, Debjani Das (13 April 2002)
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Medicalisation and health
- William House (9 December 2002)
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Soumitra Shankar Datta, Registrar, Department of Psychiatry, Christian Medical College, Vellore, India, Pin Code: 632002, Debjani Das
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Dear Dr.Sen, Your Editorial in enlightening, and at the same time has certain philosophical objectivity. It is true, as you say the recent race to focus on having a healthy body and also a mind is quite unhealthy in itself. In the developing countries like India the social matrix is interesting when we consider the mixture of traditional view points and the western influence following information revolution. Extremes are more of a rule, than exception. But the facts and figures quoted from the official statistics are often biased due to lack of proper documentation systems. More over the emotional health in a country is often attributed to 'karma' etc which have have a more spiritual dimension than a medical model. It would be difficult to compare the emic and etic models by quantitative methods as cited by you because the explanatory models of diseaes often are totally different. Unfortunately the evaluation process is often based on the western bio-medical systems which are not sensitive to pick up the distress of the individuals. |
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William House, General Practitioner St Augustines, 4, Station Road, Keynsham, Bristol, BS31 2SR
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EDITOR – The absurdity of non-diseases underlines the sickness in contemporary medicine; the problem is ours. Patients do not come with the wrong problems, we try to understand them in the wrong way. This was a central thesis of Illich1, whose ‘shadow … hangs over’ the recent BMJ themed issue on medicalisation2 (to which page numbers below refer). Most of the problems Illich described are worse today. Why have we not heeded his warnings? As Richard Smith states (p923) his writing is ‘more polemic than analytic’, and often frankly confrontational. Furthermore, there are huge vested interests in keeping health care (and patients) in their current state of misery and sickness (p886), whilst the drive towards accountability is effectively casting this deeply flawed system into stone. However, there is another more cogent reason for neglecting the warnings – the lack of an alternative. The alternative should be based on health not disease. Disease theory and bioscience have enabled remarkable developments, but medicalisation shows that they fail when placed centre stage. Amartya Sen’s paper beautifully illustrates this difficulty (p860). This problem cannot be ‘managed’ or ‘evidenced’ away because it involves questioning the ends of medicine, as well as the means. The task is daunting because health care in developed countries has strayed so far away from health. The required change amounts to a paradigm shift. As Kuhn wrote (in relation to science) these revolutionary changes occur when accepted theories are insufficient, but only when a better alternative is available3 . Health is a holistic property that may defy definition (p883) but can be understood and used. This requires the right sort of human relationship (not consumerist), an active right brain, and a new framework of conceptual thought. This is all possible, but only if we have the courage to finally grasp the nettle handed to us by Ivan Illich 26 years ago. There are many unhappy doctors looking for a new way4,5 (p866). Now is the time to provide one. All credit to the BMJ for putting this on the agenda. 1. Illich I, Limits of medicine: medical nemesis: the expropriation of health. London: Marion Boyars, 1976 2. BMJ;324 13April2002 3. Kuhn TS, The Structure of Scientific Revolutions. Chicago: Univ of Chicago Press, 1996 4. Edwards N, Kornacki MJ, Selversin J, Unhappy doctors: what are the causes and what can be done? BMJ 2002;324:835-8 5. Ham C, Alberti KGMM, The medical profession, the public, and the government BMJ 2002;324:838-42 |
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