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Health, Emotion and the Body

2010; Wiley; Volume: 32; Issue: 3 Linguagem: Inglês

10.1111/j.1467-9566.2009.01236_1.x

1467-9566

Mike Bury,

Empathy and Medical Education

Bendelow, G. Health, Emotion and the Body . Cambridge : Polity Press , 2009 viii+168 pp. £15.99 (pbk) ISBN 978-0-7456-3644-5 Apparently, Andre Agassi hates tennis. Despite untold wealth, possessions, fame and sex appeal he is not a happy man. The stress of constant competition has taken its toll. ‘I’m a young man, relatively speaking. Thirty-six. But I wake as if ninety-six. After two decades of sprinting, stopping on a dime, jumping high and landing hard, my body no longer feels like my body. Consequently, my mind no longer feels like my mind.’ (Guardian, 29th October 2009). Whether we are tennis players or not, we can readily recognise Agassi’s problem. The mind and body are linked. Tennis players, teachers or train drivers can all feel tired and worn out, physically and mentally. The emotional states that are involved in both spheres of experience, and which mediate mind and body, are also very familiar. In Health, Emotion and the Body, Gillian Bendelow sets out a cogent and intelligent account of the implications of mind/body interactions for health. In essence, she sees a clear opposition between a ‘mechanistic’ or ‘dualistic’ model of (evidence based) health, and one based on ‘holism’ or ‘integration’. Rather than separating mind and body (which, she argues, is the downside of Descartes’ contribution to human knowledge) latter day postmodern medicine draws on patient experience, the subjective realm and alternative practices and perspectives. The gains for human health made under the auspices of ‘mechanistic medicine’ are fully recognised and conceded in Bendelow’s discussion. To do otherwise would be to fly in the face of the available evidence and the realities of everyday practice in medical and surgical settings. Procedures such as coronary bypass surgery and hip replacement (to mention only two) have saved the lives and prevented disability for countless numbers of individuals. Hip replacement relies on a bioengineering model of the human body; the development of artificial joints is a testament to the success of mechanical design and durability. And who can doubt the value of regarding the heart as a ‘pump’? Nevertheless, today’s medical arena can hardly be summed up, let alone reduced to such benefits to humankind. As Bendelow points out, in areas such as primary care and psychiatry (though not confined to these) the role of human emotions is increasingly evident. In a series of chapters on stress, medically unexplained symptoms, the treatment of psychological distress and complementary medicine, Bendelow shows how mind and body are often inextricably linked and how modern healthcare has failed to see the patient in the round. In a chapter on stress, for example, she examines how the social and psychological nature of people’s lives offers both a context and a limited explanation for bodily ills. Echoing researchers such as Marmot, Bendelow argues that ‘less powerful people, therefore, face a structurally inbuilt handicap in managing social and emotional information’. Yet, in psychiatry, laboratory research (or that concerned with twin studies and the putative genetic story they reveal) dominates the field. Social psychiatry has all but disappeared from much of the research landscape. The dilemmas of promoting a more holistic model of health are not lost on Bendelow. In her discussion of medically unexplained symptoms she can see that ‘somatizing’ has social functions for patient and practitioner alike. Whilst medicating young people because of ‘attention deficit’ or ‘conduct’ disorder is clearly of concern, the ability to label problematic behaviour and respond to it in less punitive ways has its attractions. Bendelow notes that parents and teachers, confronted with highly disruptive behaviour, may well prefer medicalisation rather than school exclusion and isolation. At the same time these dilemmas only serve to underline the important linkages between mind, body and society which need better conceptualization and systematic research. It is a mark of change occurring in many parts of the health care system and medical arena that many of these arguments will, today, receive a more sympathetic hearing than they would have done even a few years ago. Bendelow quotes from recent articles on ‘disease mongering’ in the BMJ. Documents such as NICE guidance on ADHD indicate that medical (read drug) treatment for many mind/body or behavioural problems can only be part of a broader response. In each of the chapters, case studies, taken from previous research undertaken by the author, are used to illustrate the argument being developed. In the chapter on psychological distress, we are provided with the poignant case of ‘Maureen’, whose life is blighted with negative social and personal experiences, but for whom all the treatment in the world cannot prevent her untimely death. The medical response of antidepressants and tranquillizers (made worse by a serious alcohol problem) in Maureen’s case, is used by Bendelow as a backdrop to a trenchant critique of modern psychiatric and pharmacological practice. Following David Healy’s argument, Bendelow notes that unlike antibiotics in cases of treatable infections, antidepressants cannot effect a cure. At best they can alleviate symptoms. Without an appreciation of the wider context of ‘the mindful body’, the underlying causes remain. At the same time, Bendelow notes that in relation to the impact of deprivation and poverty on mind and body, practitioners will often feel that calls for change can often sound utopian –‘admittedly, with some justification’. It is widely accepted that recent declines in the suicide rate are partly due to improved treatment. Whether the topic is stress, mental health or alternative medicine, Bendelow makes out a persuasive case for a more ‘integrated’ approach to many, if not all health problems. If some of the discussion relies, perhaps, a little too heavily on repeating the ills of ‘Cartesian dualism’, and some of the critiques of modern medicine tend toward the sweeping variety, Bendelow’s discussion is always thought provoking and often mindful of its own limitations. The final part of Health, Emotion and the Body tackles the dilemma that ‘holism’ may turn into a populist and obsessive ‘healthism’. By distancing ourselves from bad old mechanistic medicine and embracing good new integrated models (with patient experience and subjectivity as their watchwords) medical sociology may be encouraging a greater level of medicalisation than it recognises. Bendelow’s discussion of this issue, like so much else in the book, offers plenty of food for thought.