April 17, 2017

What If We Stopped Trying to Fix Patients?

Ryan Kelly

By: Ryan Kelly

For pre-meds, this question might sound sacrilegious. Downright blasphemous. Why would we want to stop fixing people?  

It’s a counterintuitive idea, but that’s only because we’ve been conditioned as a society to search for an immediate solution or fix to people’s problems.

As aspiring doctors, pre-meds should reflect on their outlook and potential methodology, especially when dealing with chronic conditions.          

A 2016 NPR Invisibilia podcast, “The Problem with the Solution,” suggests that there are problems we shouldn’t try to fix, and that if we try, our solutions might contribute to the problem.

The podcast mainly focuses on mental health. The hosts, Alix Spiegel and Lulu Miller, question whether our constant drive for solutions is detrimental when treating mental illness. They tell the tale of Ellen Baxter, a young college student in the early 1970s who faked her way onto a medical ward for investigative purposes. Baxter was deeply troubled by what she found:

“I didn't see any therapeutic activity taking place with any other people on the ward at that time. So people would hang out, looking out the windows, waiting for the bells to ring. Time for the medicine line… time for morning snack. One can almost see the humanity of people evaporating.”

Baxter was dissatisfied by the “solution” to mental health in the form of pills and detached asylum. In her research, she stumbled upon a small town in Belgium named Geel, where citizens welcomed mentally ill strangers into their homes. Throughout history, people made a pilgrimage to the town to honor Saint Dymphna, the patron saint of the mental illness. A certain tradition of acceptance grew, and by the 1930s, a quarter of the town was mentally ill. Baxter was intrigued by this radical attitude and lifestyle:

“The atmosphere in the town is conditioned by many years of exposure to mental patients. I have seen coffee served in a cafe with as much deference to actively hallucinating psychotics as to anyone else.”

This deference has led to the town’s nickname, Paradise for the Insane. There's a large medical facility right in the center of town, where patients visit when they first arrive. They're prescribed medication and paired with a therapist. Then the doctors discuss and choose which family the patient will live with. Surprisingly, the host families are never told the diagnosis of the patient. A local doctor explains why:

“Because people have their idea - schizophrenia, you should do this and this and this and this. And that's what we do not want them to do. We just want them to share family life with them - share life and do not treat them.”

Baxter has attempted to emulate this approach in the U.S. by managing 70 apartments in Harlem and Washington Heights, where 30% of tenants have severe mental illness. They live alongside people who are mentally healthy, and the system appears to work well on this small scale. However, many experts, like Harvard psychologist Jill Hooley, think it would be challenging to replicate Geel in the U.S.

Whether or not we revolutionize our care of the mentally ill remains to be seen. Regardless, the podcast raises questions that offer important insights for pre-meds. First, it reveals the importance of learning how other cultures around the world view healthcare and its practices. Even if you don’t fully agree, it’s enriching to have your perspective challenged and broadened. Second, it sheds light on the fact that every patient has different needs, desires, and preferences, so prescribing one solution for the same problem or illness can potentially be harmful. Lastly, it reminds current and future caregivers about the importance of not sacrificing our humanity in the name of efficiency or a quick fix.

As always, it’s highly recommended.

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