The Other Side of Medicine - Depression, Disease or Disaster
After 30 years as family doctor it seemed a good time to collect ones thoughts together. I was helped in this task by being asked to contribute a regular column to the UK journal, Education for Primary Care. So for five years this gave me the opportunity to reflect upon issues in medicine and training of doctors. I was in Vienna recently and visited the museum of the most influential psychiatrist ever, Sigmund Freud. To be honest he has never been a hero of mine, and my assessment is that he contributed more than his fair share to the development of the introspective self indulgent society we have become. A clever, brave, irascible and eternally curious man, who spent the latter years of his life trying to prove that the iconoclastic Pharaoh Akhenaton was in fact the biblical Moses; he may have been right but he certainly was not right about the interpretation of dreams or the mumbo jumbo that became the religion of psychoanalysis. During my visit the inner sanctum was filled by a large group of mainly young women who would not be moved on, their eyes shone, they exuded excitement and awe; it was if they were in the presence of a deity, there was not a shadow of a doubt that they ‘believed’ in Freud at that moment. Belief is part of our problem with depression; psychiatrists have chiselled out a syndrome with clear markers and definitions, this is now widely accepted by our society who now firmly believe in depression and GPs who are part of society are the faithful disciples who diagnose it day in and day out, whether too much too little or about right depends on your viewpoint. Shellshock which has slowly metamorphosed into PTSD is an interesting comparison; Pat Barker’s wonderful Ghost Road trilogy reminds us of the absolutely brutal treatment of this condition during and after the First World War. At that time society and psychiatrists did not really accept a severe stress reaction related to horrific experiences, there was an underlying feeling of incipient cowardice laced with a certain lack of moral fibre. This allowed a small band of ‘Physical Psychiatrists’ to effectively torture patients out of their symptoms, the success rate was very high. Nowadays Depression is accepted as a legitimate reason for killing oneself, for having long periods off work, for retiring early, for not looking after oneself or others and perhaps most importantly it is a gold plated admission to the ‘sick role’. You may have detected a whiff of cynicism on my part, but in reality I am just as confused as you are. There are many people who appear depressed by the criteria we currently accept who get better if they take the tablets prescribed by me, irrespective of apparent causation or lack of it, and are grateful for my ministrations. There are others who don’t but who are helped by other methodologies, from the still mysterious ECT, to CBT, to group and family therapy, to one to one structured or unstructured counselling etc. When I was a ship’s surgeon more than 30 years ago, the ex RN dispenser who treated the crew had a 3 stage treatment for depression, stage 4 was to see me, it went like this; 1. “Pull yourself together and here is a bottle of red medicine”. 2 “Not you again, bl**dy get out more and here is the stronger green medicine.”3 “Right! This time it’s the Black Draught for you. Take it twice a day and I don’t want to see you back.” The black draught was liquid senna and I never saw a case of depression. The culture on the ship was not conducive for the illness. If you would like to read more about these experiences go to http://www.lulu.com/petertate and purchase Seasickness. Of course many famous people have suffered depressive episodes two that come to mind are Churchill who had the family ‘black dog’ and Spike Milligan who was famous for his manic depression, both however led startlingly successful lives. The involutional melancholia of the Victorian’s was recognisably similar to the modern syndrome and in the century before that Dr Johnson remarked “Melancholy, indeed, should be diverted by every means but drinking”; to my own chagrin I went through a short phase myself, hated the loss of control over my mood and was mightily relieved when one day it just went, without treatment. So I repeat, what is it? And when should I prescribe for it? The underlying current in my mind is just how useful is this societal medicalisation of mood? The oft asked question is where does unhappiness stop and depression begin and last years massive tsunami can help us focus on the answer. In the outpouring of aid for Sri Lanka, Indonesia, Southern India and Thailand were there crates of citalopram as well as bus loads of counsellors? And if there was how much good did they do? We do know now that in many cases so called counselling in disaster situations does more harm than good which leads one to further suggest that the depressification of human distress, misery, mourning and frustrated goals is an inherently bad adaptive strategy and only tolerable in a society that can allow itself that luxury. Peter Tate qualified as a doctor at Newcastle in 1968. After spells as a P&O Surgeon and as a trainee in Kentish Town he was a family doctor for 30 years. He was an MRCGP examiner from 1981and was responsible for the introduction of the Video module in 1996; he retired as convenor of the panel of examiners in March 2006. He is the sole author of The Doctor’s Communication Handbook now in its 5th edition. He is also the author of The Other Side of Medicine, a collection of essays and short stories. He has also recently published Seasickness, a novel based on his experiences as a young ship’s surgeon. He was a co author of The Consultation and The New Consultation OUP. He has lectured widely on communication issues. He is now semi retired and lives in Corfe Castle. His recent medical books are available from Amazon and www.radcliffe-oxford.com. Seasickness is also available from www.lulu.com/petertate |
Other Articles
How Good Writing Becomes a Wonderful Book Every book was once a mere snippet of a notion with a pencil (or a computer keyboard) dangling off the end of it. The difference between an author and someone daydreaming out the window is that, finding the pencil or keyboard attached to a notion, the writer continues drawing, writing, pulling, prodding, and scratching at the notion until it bec ...The Other Side of Medicine - Depression, Disease or Disaster After 30 years as family doctor it seemed a good time to collect ones thoughts together. I was helped in this task by being asked to contribute a regular column to the UK journal, Education for Primary Care. So for five years this gave me the opportunity to reflect upon issues in medicine and training of doctors.I was in Vienna recently a ...Attract More Buyers to Your Book: Use Metaphors Surprise your potential buyers. Give them chocolate frosting!After we entered school we had a lot to learn. We left the sand box, the nap, and the all day playing with our imagination. No wonder we have lost touch with our original, playful, creativity. Now in the information age we expect to read short, concise pieces. Yet, we can, if we ...What is a Virtual Book Tour This is one of the many questions I’ve had to answer since starting on my nationwide virtual book tour on November 1, 2006 – November 30, 2006 to promote my first self-published promoting eBook, “A Complete Guide to Promoting & Selling Your Self-Published eBook.”Because I feel that this is a wonderful way to promote your books, whether th ...Straight From the Publisher--The Enticement Package Publishers sometimes mention the enticement package when talking about a book’s marketability. What this refers to is the impact from the combination of cover design, title, subtitle, back cover text, reviews and endorsements, and the Table of Contents (if nonfiction) and Introduction.Here is why this is important. Most books are sold to ...A Writer’s Influence Never Stops! I can say at least two things about my loyal book readers and clients:(1) They never stop marveling about the fact that my sales, customer service, and telephone techniques still work for them; and(2) They never stop marveling about the fact that I’m STILL ALIVE and very active in my consulting practice.They don’t know that ...Why Should I Buy your Book? How would you like to have countless people clamoring for your books and willing to visit your Web site to buy them?Most entrepreneurs wait until their Web site is designed before they think about marketing their products on it. What a shame!When someone asks you about your book, maybe you've said, "My book is about…." You mention ...Comics Books: Our Own Worst Enemy? Like most comic publishers I spend quite a bit of time thinking about the state of the industry and how to make it better – well, truthfully, how to make my little corner of it better. After spending a lot of time thinking it over and discussing what everyone perceives to be the main elements leading to the downfall of comics (the distributor mo ...A Stitch In Time - Saves A Stitch in Time Saves NineI’m sure you’ve probably heard someone say, “A stitch in time saves nine”, but did you ever really think about it? In the context of fixing something that is ripped it means getting out the needle and thread and fixing the tear before it becomes too large to be fixed. It doesn’t mean letting it sit in the sewi ...Extend Your Book's Life With a Sales Letter Authors, publishers and business owners are great at getting their books written and launched. But after the initial one-year honeymoon, sales slow down. To counter this, make sure to let your audience know about your book's benefits and how it can help them in their lives. Keep your book alive and selling well for years when you write a sales ...Speaking for a Publication Why write a book and get attention and loads of contacts?Expertise can sometimes be defined by the articles, columns, responses and books you write. It does not take a lot of effort to write the articles and columns but it does take effort to write a book. Having a book behind your name shows your expertise. After all, you were able to wr ...How He-Who-Can't Be Named Builds a Platform My name is Author Jones and I have an astronomical book idea. The enjoyable subject matter is really super awesome good. Oh, I know 195,000 books come out a year, Jane Agent, and most of those sell less than 500 paltry copies. I am not famous--I am coming at you from the knowledge that simply writing a good book and going on an ...Ten Ways to Make Your Book Outsell Another Wouldn't you rather write a book that sells well than be stuck with unsold inventory? When you plan ahead with the 10 tips below, you will sell thousands rather than hundreds of your unique and important information or inspirational products.1. Write non-fiction first. These books are 90% of total book sales. After non-fiction success, yo ...Never Pay Full Price for a Book! Are you an avid reader? Are you trying to instill a love of reading in your children?My whole family loves to read! Right before bedtime every night, every one of us can be found with our nose in a book!It would be very easy for us to spend a fortune every month on books. But, since we don't have a fortune to spend every month, ove ...How to Design a Book Cover For Self-Publishing In your quest to self-publish your novel or short story, you may run into a little trouble with how to design a book cover. There are several ways to make an attractive cover for your book, but most writers fail in this particular area because they can't afford the photo editing software or don't trust their artistic abilities enough to do the ...10 Reasons Why People Attend Book Signings This is the survey result of 325 people conducted by myself so I can improve at my own book signings. After completing the survey, I saw the wealth of insight it had given me. I felt it was important to share it with a wider audience. I also interspersed some personal experiences.The survey was conducted by Catherine in-person with peopl ...Writing The Blockbuster Book Proposal: How To Sell Your Non-Fiction Book You did it. You crafted the perfect query letter for your non-fiction book, and as a result, an editor at a large publishing house has requested a full book proposal. At this point, you have a 50/50 chance of seeing your work on a bookstore shelf. The difference maker will be a strong book proposal that exhibits knowledge of your audience, wha ...Increase Book Sales: When a Book is No Longer Just a Book for Sale Do you have books sitting in your garage that you haven't sold yet and looking for ways to move them? Then you will want to know about these five outrageous ideas that aren't difficult and can be just plain out fun.Dede Hall, author of The Starving Student's Cookbook had very poor sales for her books. Then one day an outrageously light ...I Think I Need an Agent Your initial manuscript is complete. Maybe it's even been shelved for a period of time. You may have sent the manuscript to a publisher, but it never really went anywhere. You really believe in the book, but are tired of hitting the roadblock that reads, "No unsolicited manuscripts".Maybe what you need is a literary agent; one who believe ...How to Market Your Unsold Books on the Internet: It's Easy Your book expresses your wondrous information, your creativity, your genius. It's your dream come true. Or is it? You have already tried a few venues--maybe an expo, book signings, press releases, book reviews, distributors, wholesalers, speaking and book tours. Your aren't selling much.Now, there is a new way to market those unsold books ...
|