Every innovation has its unintended consequences.
In Chapter 1 of Healing People, Not Patients, I talk about the revolutionary new curriculum at my medical school in 1999, which taught the basic sciences of medicine by organ system, instead of the old arrangement of anatomy, physiology, pathology, and pharmacology. We got all four of those at once, system by system.
The unintended consequence is that this unnaturally and unnecessarily splits diseases, body parts, and people in general into separate silos that ultimately must work together to make a functioning human. It begins the Balkanization of the human body (thank you to my mentor Devra Davis for that phrase) from day one of medical school.
In Baltimore the other night, I was sharing this thought with the group I was speaking to, and one of them remarked, “Well, that’s really interesting. The brain is a very important organ, and it seems like we ignore all the mental health issues that are going on in people, that happen in the brain.”
He had a point.
What’s fascinating is that when I studied the brain, we had a neurosciences course that covered brain anatomy and the neurological diseases (localizing a stroke, diagnosing vertigo, understanding the genetics of Huntingdon’s Chorea) – and then a separate class called Psychopathology and Society.
Apparently Balkanizing the body wasn’t enough – we had to do it to the brain also.
I didn’t get to answer the question Sunday night, so I’m answering it now. No – there is no earthly reason why we should split the brain into the neurological and psychological parts. You know the implication – neurological disease is real, psych is somehow less so. But what could be more real than a disease that makes it impossible to distinguish reality from fiction? That makes a person constantly fearful of the smallest noise? Or that fills a soul with a powerful desire to end its own life?
At the same time, so much of what we think of as “psychiatric” is the painful, raw ebb and flow of human life: untimely deaths of loved ones, overwhelming stress from conflicting responsibilities, disappointment and failure, and the psychic pain that results from it. If we do put the two “halves” of the brain back together in our medial model, are we just medicalizing what is supposed to be normal reality? It reminds me of the dodge one of my kids worked out when he does something inexplicably wrong: “My brain made me think it was OK….”
Finding the line between dismissiveness and overdiagnosis is tricky. But I’ll try:
Don’t start with the brain at all. Start with the person. Start with the story. Sometimes, the major plot line in the story will unfold as multiple sclerosis. Sometimes schizophrenia. And sometimes sisters having a screaming argument (not picking on sisters – it’s just good alliteration). What you want to know is how the story will turn out – and how much influence you can have on the outcome, whether you are the healer or the main character. Brains don’t get stories written about them – people do.
1 comment so far