Public health does not follow from conformist psychiatry
Bedside manner, wealth extremes, and sane institutions are life-and-death
Doctors show little empathy, inequality loads on the stress, and psychiatry ignores the maddening institutions. Not a panacea but a necessary correction is economic justice. We trim, blend, and append three 2008 articles: from USA Today, Sept 22 by Rita Rubin; from Health Beat then AlterNet, Sept 4 by Maggie Mahar (author of Money-Driven Medicine: The Real Reason Health Care Costs So Much); and from AlterNet, Sept 11 by Dr. Bruce E. Levine.
by Jeffery J. Smith, October 2008USA Today: Physicians could use a lesson or two about how to care for their patients' psyches; cancer specialists and surgeons rarely responded with empathy to patients' concerns.
Researchers assessed transcripts of 20 audio recordings of consultations between men with lung cancer and surgeons or oncologists at a Veterans Affairs hospital. The transcripts revealed 384 opportunities for the doctors to show empathy -- patient comments such as "this is overwhelming" and "I'm fighting it" -- but they missed all but 39.
Previous studies have shown that patients whose doctors show empathy are more satisfied with their medical encounters, which leads to a better understanding of their condition and lower anxiety. That, in turn, can help patients survive the operation.
Health Beat: However decent the doctoring, not everyone can afford it. "Income, Poverty, and Health Insurance Coverage in the United States: 2007" is a recent report by the Census Bureau.
From 2002 to 2006, the average income of the top 1 percent grew about 50 percent in real terms, from roughly $850,000 to $1.3 million. The richest 1 percent of households held 23 percent of income in 2006. The only year of greater income concentration was 1928 (24 percent).
As for the middle class, from 2000 to 2007 median household income fell by more than $2,000 to $50,233.
If you earn $50,000 and have insurance -- but still have to pay $5,000 out-of-pocket on medical treatments that your policy doesn't cover -- does that piece of paper really deserve to be called "insurance"? If you earn $40,000 and have a $3,500 deductible, you may skip mammograms and Pap smears and not have your eyes checked. This is "insurance" in name only.
Health care is one of five factors that influence wellness with genetics, social circumstances, environmental exposures, and behavioral patterns. Where the patient lives -- social circumstances and environment -- explain 20 percent of premature deaths, while behaviors such as smoking account for another 40 percent. And those behaviors are, in turn, closely correlated to the patients' income and education.
The most consistent predictor of the likelihood of death in any given year is level of education; persons ages 45-64 in the highest levels of education have death rates 2.5 times lower than those of persons in the lowest level.
Each 1 percent rise in income inequality (the income differential between rich and poor) is associated with a 4 percent increase in deaths among persons on the low end.
Poverty has been estimated to account for 6 percent of US mortality. In poor neighborhoods, the housing is substandard, recreation limited, air polluted, crime rate high, schools of low-quality, with few or no decent medical services nearby. Stores sell high-carb, high-fat foods that are more affordable than fresh fruit, vegetables, fish and other proteins.
To the resulting stress the body responds with an enzyme that over the long run weakens its resistance to illness. The mind, in many cases, responds with choosing to smoke and drink too much.
More than 25 percent of Americans suffer from some form of mental illness, including depression. Mental health, too, correlates with economic inequality. Life in the lower class means a lack of control over one's life circumstances, increased social isolation, and the anxiety brought about by a subjective feeling of being of low social status.
AlterNet: Might fewer people feel out of touch in a healthy society?
Erich Fromm: "An unhealthy society is one which creates mutual hostility (and) distrust, which transforms man into an instrument of use and exploitation for others, which deprives him of a sense of self, except inasmuch as he submits to others or becomes an automaton."
Many mental health professionals -- including non-prescribers such as psychologists, social workers and counselors -- merely assist their patients to adjust but neglect to validate their patients' alienation from society.
Many American institutions promote helplessness, passivity, boredom, fear, isolation, alienation, and dehumanization. One-size-fits-all schools, the corporate workplace, government bureaucracies and other giant, impersonal institutions routinely promote manipulative relationships rather than respectful ones, machine efficiency rather than human pride, authoritarian hierarchies rather than participatory democracy, disconnectedness rather than community, and helplessness rather than empowerment.
While one could point to societies less sane than the United States, this does not make America a sane, humanistic society.
JJS: George Bernard Shaw, an advocate of proto geonomics, said: “The reasonable man adapts himself to the world; the unreasonable one persists in trying to adapt the world to himself. Therefore, all progress depends on the unreasonable man.”
Progressing to geonomics might foster sanity. People would no longer be taxed under threat of arrest but instead duly compensate one another for the portion of Mother Earth each claims. And instead of being force fed social “services” which one had no say in shaping, we'd all receive a share of society’s surplus, of the collected payments for owning some Earth.
Then we'd tend to see ourselves -- even doctors and shrinks -- as equals, who could enjoy both the freedom and the responsibility that lets us be healthy and become more fully human.
Jeffery J. Smith runs the Forum on Geonomics.
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Is it physical or psychological?
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