Parallels and Paradoxes
Post-Brexit; Austerity winners and losers; Nationalism vs accepting immigration; Black Lives Matter; Corbynistas vs Blairites; U.S. gun control; Trump vs Clinton: There has been plenty of media discussion focused recently on the idea of a divided society. Perhaps this is an oversimplification. Do societies really exist in binary terms; Us and Them? The notion of multiple tribes interacting and working together for the common good is one of the fundamentals of ‘civilised society’. Of course, it is very personal where we place ourselves on the individualism/ socialism spectrum and how are beliefs are shaped, which is why politics and religion are so potentially divisive.
These issues are analysed by sociologists and political scientists, amongst others, but there is also a healthcare implication. The philosopher, Jiddu Krishnamurti (1895-1986) coined the term: ‘The Sick Society’. Having lived through colonisation and two World wars, his comment was certainly informed by personal experience. What he actually said was: “It is no measure of health to be well adjusted to a profoundly sick society”. Perhaps the unease we may be feeling at the moment is, in fact, a perfectly healthy response to a troubling situation. Dis-ease as a response to disease. In the same way, our minds produce the subjective sensation of pain in response to a disturbed state.
We pride ourselves on providing highly individualised healthcare for those seeking our help. There’s the rub (pardon the pun). Evidence-based (with appropriate measures) and socialised medicine can provide data for what might be best for most of the people most of the time but often is not helpful when it comes to determining where the individual patient ‘fits’ into the scheme of things. Describing them as ‘typical’ or ‘atypical’ is, again, divisive, oversimplified and unhealthy. Many of our patients come with presenting symptoms that do not fit into the classic diagnostic boxes and the challenge is to combine the best of generalised accumulated medical knowledge with the detailed history of the individual person.
Within the individual there is again the concept of division. Aristotle and Plato explored the idea of multiple souls but it was René Descartes (1596-1650) who described the dual nature of human existence. Often called mind-body (Cartesian) dualism, it refers to the relationship between the physical (body) and spiritual (mind). Unfortunately, this has often been misrepresented in modern times as if the brain and body are independent entities. The body reflects the mind (and has been described as the graveyard of the emotions) and is the life-support system for it. Neural plasticity determines that there is a self-repairing dynamic equilibrium (termed ‘homeostasis’ by Walter Cannon in 1926) within the mind as there is in all other physiological systems. It is when this breaks down that ill health can occur.
R.D. Laing (1927-1989) was a Psychiatrist whose revolutionary approach separated the lived experiences of the individual patient (suffering from mental illness) from accepted generalised medical diagnoses. In 1960, his seminal work ‘The Divided Self’ was published. In this, he used case studies to show that psychosis is not a medical condition but an outcome of the ‘divided self’ or tension between the two personas within us: one our authentic, private identity, and the other the false ‘sane’ self that we present to the World. Dr Jekyll and Mr Hyde or Yin and Yang? It is interesting to note that the Yin and Yang pictogram, shows there is an element of each in the other.
Previously, Sigmund Freud (1856-1939) and others looked at what were considered to be the ‘animal instincts’ that are suppressed in the ‘civilised’ individual and in ‘civil society’. They looked at the mechanisms by which this suppression occurs, to better understand what happens in individuals and societies where unrest has broken out. The term ‘sublimation’ was borrowed from the writing of Friedrich Nietzsche (1844-1900) and Freud likened it to maturation. So, the mature individual has a moral compass and the mature society has an ethical compass. What happens, however, when the magnetic poles are changed or distorted?
Sick individuals lead to a sick society and vice-versa. Just as Utopia is a mirage, so is the ultimate ‘perfectibility’ of the individual (as described by Jean-Jacques Rousseau (1712-1778) in his study ‘On Education’). We are constantly teetering on the brink as a society and as individuals. Homeostasis is necessary for both.
David Propert, BSc (Hons) (Ost), FHEA, FRSH