In psychiatry we’re taught to consider our patients in “biopsychosocial” terms. This is useful, but the term has become a bit of cliché. If I mention it when teaching medical students I can see the lights go out in their eyes.
I wonder if this is because when we analyse the roots of our patient’s distress, we only think in local, individualistic terms. For biological, we think of their aunt with schizophrenia and their coke habit; for psychological, we think of their limited coping mechanisms at times of stress; for social, we think of their crappy council flat. This is neither inspiring nor completely “holistic”—another stale stock phrase.
It would be far more valuable to have a broader view, to consider not just the biopsychosocial factors in the immediate vicinity of the person we are treating, but the root causes of those factors on a national scale. We need to consider the economical, the environmental, the judicial—in short, the political aspects of the illness we encounter.
When Virchow eruditely said that “politics is nothing else but medicine on a large scale,” he wasn’t just being poetic. He was bang on. Every precipitant of ill health in our country—be it biological, psychological or social—is under the direct and weighty influence of politicians.
Some examples of this are obvious, especially the biological ones. The smoking ban has been a huge success, echoing similarly protective seatbelt legislation. Plain cigarette packaging will arrive in 2016, but neither a minimum unit price on alcohol nor a sugar tax seem particularly close to fruition. The UK drug classification system remains a science-free zone.
The psychological and social effects of political policies on health often come together. Poverty breeds both mental and physical infirmity. Those in the poorest communities are ten times more likely to take their own lives than those in affluent areas and two and half times as likely to have diabetes. Someone is 50% more likely to be obese if they have no qualifications than if they have a degree. Seven percent of UK combat troops report having PTSD due largely to purely political decisions to go to war. These are statistics for which fluoxetine and metformin are not the answers—education, financial assistance, jobs and diplomacy are.
The underlying point is, if politicians are essentially doctors on a large scale, then doctors should try to be politicians on a small scale. When we see patients, we should always be thinking of the wider reasons for our patient’s ill health, and mulling over what policies could prevent further suffering. We should advocate for such policies, lobby our MPs, and when the time comes, take the only chance we get to make a concrete mark on the biopsychosocial politics of this country. Vote.
Competing interests: None declared.
Alex Langford is a core psychiatry trainee from south east London. Twitter @psychiatrySHO