Heroes Not Zombies

Why Do People Get Ill. Darian Leader and David Corfield. ISBN 978-0-241-14316-2. This is a book written by a psychoanalyst and a philosopher. Amy spotted a review of it in The Observer. It gripped me from the outset – always a sign of a good book I reckon. In the first few pages these statements caught my eye –

3.5% of the decline in mortality due to infectious disease since 1900 can be attributed to pharmacological intervention

5 – 10% of healthy adults and 20 – 40% healthy children carry it [streptococcus pneumoniae]

Typhus and dysentery will flourish with greater success in defeated armies rather than victorious ones.

The first of those quotes is really interesting because there is now a huge emphasis on drugs as being, if not the only, then certainly the best, treatments (and cures) for most illnesses. Antiobiotics in particular have achieved almost mythological status as saviours of suffering humans. Yet they are only responsible for a tiny percentage of the lives saved from death from infection. What are the big saviours then? Well, clean water, effective sewerage systems, better housing and reductions in poverty are amongst the main ones. This is not news. I learned this in “Sociology in relation to Medicine” (a course in my undergrad medical course at the University of Edinburgh) in 1972 (and it wasn’t new then!)

The second quote tells us that loads of people have “nasty” bugs (we have a terrible tendency to describe some bacteria as nasty and some as nice, entirely on the basis of the potential harm they can cause us – nothing to do with the personality characteristics of bugs!) which apparently don’t seem to be causing them any harm. How come?

The third quote claims that mortality from a serious infection like typhus is affected by the mental state of the individuals who catch the bug. This is one of the key points of this book. These observations are not new to me and they probably are not new to you but when you stop for a moment to think about them they are startling and they tell us loud and clear that illness is not a mechanical process. Illness is always multifactorial. That’s part of the nature of complex systems – they aren’t simple! This sets the tone for the whole book. The thrust of the argument is that it’s whole people who get ill, body and mind, inextricably interfunctioning, and not only that, but it’s whole people, embedded within the environments of their lives who get ill. I use the plural there deliberately. We are embedded in multiple environments, not just physical ones, but also social, cultural and narrative ones. We are meaning-seeking creatures and the fascinating examples in this book illustrate that point beautifully.

The question the authors ask of us is to consider not just what is this disease? but doctors should ask their patients to talk about themselves

No hospitalised patient should be deprived of the opportunity to speak about themself.

Intruigingly they explore the potential for illnesses to emerge at symbolic times and in symbolic ways

Human culture is built up of symbolic structures, involving language, social laws and ritualised practices…..growing up involves the absorption of the social and linguistic structures into the very fabric of the body.

This is a plea for a more human, more humane practice of medicine. A plea for the recognition of the importance of a person’s narrative and the importance of human relationships. They question, for example, the wisdom of a system of delivering health care which results in the patient never seeing the same doctor twice. The current emphasis on protocols and targets is dehumanising. It assumes that every patient with disease “x” can be treated with therapy “y” and it doesn’t matter who actually delivers the treatment. How did we come to value drugs more highly than human beings? Technologies more highly than caring attentiveness?

The health services and bureaucracies of contemporary society are based on a rejection of the very dimension of human narrative.

Their final challenge is –

challenge the thesis that the disciplines basic to medicine are physics and chemistry. Would it be absurd to suggest that literature and philosophy would make better candidates, as they encourage the study of human beings living in a world of meaning.

Hear, hear, guys! Occasionally you read a book you wish ALL doctors would read. This is one such book. Sadly, a lot of doctors don’t read very much, claiming to be “too busy”. Suggest your doctor friends buy it for “holiday reading”.