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73 7. Psycho-Social Problems and the General Practitioner The following address was delivered at the Medical Union’s Annual General Meeting in Sligo on 27 September 1973. ON reflection, a better title for this paper would have been ‘Human Bio-Social Problems and the General Practitioner’, for in real life we do not find any such thing as a purely psychic or psycho-social problem; all the things which happen to us are experiences involving our whole being. Take a typical neurosis, agoraphobia, which we would ordinarily think of as a purely psychiatric condition. The person finds himself compelled to avoid certain external situations. If he attempts to face these situations, he experiences certain unpleasant ‘symptoms’. These symptoms, when he describes them to us, we recognize as manifestations of ‘anxiety’ or ‘fear’ but if we look closely at what is happening we find they are mainly physiological: in unpleasant sensations we experience fear in the stomach, in feeling weakness of the knees, cold sweat, the heart racing and so on. The summation of these experiences we recognize as the psychic awareness of ‘anxiety’ but the total experience which we are talking about is not merely psychic it is an experience of our whole being. The same is true of any other ‘psychic’ experience we like to think of, whether depression, guilt, elation, anger or whatever. But I am going ahead of myself. What has all this to do with the General Practitioner? I think it brings to the fore some of the fundamental questions about the nature of illness or health. I imagine your response would be ‘surely any fool knows what illness is’. But do we? My impression is that, when we say we understand something – as, for example, what health or illness is – this understanding rests not on a well-thought-out logical basis relating back to first principles but rather is more likely to depend on what has been happening in the area of activity in question; what developments have been taking The Writings of Ivor Browne 74 place, for example, in medicine, over the preceding period. It is these activities and developments which tend to supply the materials out of which we build our concepts of reality. It is not so much, therefore , that the actual reality of something like illness or health changes but that our idea of what these are is influenced by an emphasis in a certain direction due to developments that have been taking place over a preceding period of time. If we look at the growth of medicine over the last hundred years it can be seen that there were enormous achievements along certain lines of development. With the introduction of asepsis and anaesthesia into modern surgery, there were great successes in the early years in dealing with burns, injuries, excision of diseased parts of the body, reparative operations, etc., moving on to the more creative and reconstructive forms of surgery being undertaken at the present time. Likewise, there were marked achievements in medicine which led to the virtual elimination of whole groups of diseases, such as smallpox, lobar pneumonia, diphtheria, tuberculosis, etc., which have been brought under control by inoculation, vaccination, public health measures and more recently by the development of antibiotics and other therapeutic measures. In these fields of endeavour, the successes related mainly to external assaults on the human being, injury or infection. Out of these advances grew an understanding of what it is felt constituted illness and, following from this, by a process of elimination emerged a concept of health (although this was much less clear as a state which is assumed to be present when one is not ill). However, if we turn now to the major hazards to health facing western society at the present time, we find these are utterly different from those which faced clinical medicine during the period of great expansion and successful intervention in the latter half of the nineteenth century and early years of this century, when the major infections and surgical conditions were being conquered. Therefore, although the real nature of health and illness has not changed, our idea of what these are will have to alter radically if we are to tackle successfully the problems facing us today, which are quite different in character to those of fifty years ago. Let me illustrate this change with but one example: the EEC. The Experts Research Committee has recently reported to the Commission that: Psycho-Social Problems...


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