Medicine By The People: Self Help Health Care

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Medicine By The People: Self Help Health Care

by Anthony Weston

‘Science for the People’ Vol. 14, No. 1, January 1982, p 24-29

Anthony Weston is a graduate student in philosophy at the University of Michigan in Ann Arbor. 

Ivan Illich argues in his critique of modern medicine that:

a professional and physician-based health-care system that has grown beyond critical bounds is sickening (sickness causing) for three reasons: it must produce clinical damage that outweighs its potential benefits; it cannot but enhance even as it obscures the political conditions that render society unhealthy; and it tends to mystify and expropriate the power of the individual to heal himself and to shape his or her environment.1

These kinds of criticisms are widely shared on the left, and at least the first is becoming a familiar public complaint. But among all of us there is also a feeling of resignation and pessimism; no one knows exactly what to do to change medicine. Small corrective changes seem pointless against the overwhelming special interests and general attitudes which underlie present medical practice.

Still, I think that there is some hope for changing medicine. This article makes one concrete suggestion: the emerging “self-care” tendencies are constructive and ought to be encouraged. I try to explain what self-care is, why I think it can be constructive, and then review some of the presently popular books in self-care and end with a challenge for further work.

What Self-Care Is

Self-care involves developing the competence to do for oneself and one’s family and friends many of the things which we now rely on medical professionals to do. Most importantly, it means developing the capacity to diagnose common health problems and to deal with them effectively without going to a doctor and without relying on expensive and possibly dangerous medications. Health maintenance and disease prevention are also involved, of course, based upon an improved understanding of the causes of sickness and of one’s peculiar susceptibilities; also implied is a greater patient participation in professional care, based on the same understanding.

Self-care in this sense is not new. Most of us deal with everyday colds and sprained ankles without going to the doctor or taking drugs. Several recent studies suggest that as many as 75% of discrete illnesses and injuries are handled without professional intervention.2 It is hard to know just how to interpret numbers like this: “handled” may simply mean “suffered through”, if people simply could not afford to get medical help, or if no help was available. Still, most of us know first-hand that much health care is carried out without reliance on professionals.

What is new is that there seems to be a growing interest in self care among people previously dependent on doctors, and for more complex problems than we now tend to treat within the family or on our own. There are now about twenty commercially available manuals on self care in general, and many more on specific aspects of it, for example, the use of non-prescription drugs for dealing with back problems. Two or three self care periodicals have also become available. The medical profession itself is taking note: a 1975 Symposium on Self Care, apparently the first of its kind, was held in Copenhagen, and produced some continuing research and publications.3 Also, the Graduate School of the City University of New York has established a National Self-Help Clearinghouse.4

The Potential of Self-Care 

Obviously, self-care implies a reduced dependence on medical professionals. If people learn to care for themselves, and to seek help from family and community, they rely less on medical professionals. Visiting doctors are certainly not ruled out, but the emphasis in many currently available manuals is on taking control oneself, and turning to friends and peers when help is needed.

A second and closely related effect would be a reduced mystification of medicine. Self-care requires that one begin to understand what is happening inside one’s body, and what can—and, just as important, cannot—be done against it. One’s body is no longer a mysterious and alien thing reserved for doctors and medical machines. Presently, even the most well informed lay people are generally ignorant of the mechanisms and proper treatments for more than the simplest sicknesses and injuries. And, of course, few people are this well-informed. People take prescribed pills without any idea of how or even whether they work. The Boston’s Women’s Health Book Collective’s Our Bodies, Ourselves includes accounts by mature women who only recently began to even look at their own genitals.

This ignorance, of course, has deeply political causes. Enormous medical incomes are made possible by patients’ dependencies. The drug companies have an enormous stake in pill-popping; sexist taboos play a central role in the ignorance of women. This suggests the single most important potential effect of the self care movement: it can heighten political awareness and lead to activism. Increased understanding of the causes of disease may reveal how much of their causation is related to working conditions and the polluted environment. Understanding how difficult diagnosis is, and what a difference long-term and emotional factors make to one’s condition, can only put one into conflict with the assembly line, single-symptom diagnosis common in large medical establishments. Understanding how uncertain the effects of drugs are, and how many negative and simply unsuspected side-effects there may be, leads not only to a reduced use of drugs, but into a necessarily radicalized attitude toward the drug companies. Women understanding their own bodies and processes can begin to realize how deeply sexist assumptions pervade the practice of medicine. 

Activism toward alternatively-organized, non-authority-based health care options is an obvious first step, and already exists to some extent. But activism within traditional, professional medicine is also implied. Patients will begin to refuse the passivity of the “patient” role: to acquire confidence in their own diagnoses, to refuse drugs, to insist on being fully informed. A few patients who refuse this expected passivity will begin to raise questions in the minds of doctors and medical personnel themselves. It is interesting that the participants in the Copenhagen symposium were quite aware of these possibilities: they are never explicitly stated, but there is an underlying recognition of, and uneasiness about, the “powerful potential of self-care to de-professionalize the health care system” and the possibility, so precisely put, that “professionals, health systems planners, and governmental bodies may have to modify many elements of their philosophies, structures, policies, and procedures to adapt to self-care.”5

Political Objections

Despite this potential, there seems to be widespread apprehension about self-care on the left. The fear is that self-care ultimately misplaces our political energies. It is seen as a way of “blaming the victim,” of making people feel as though the blame for their poor health is only theirs; the fear is that it encourages political quietism and exonerates the real, often social causes of illness. Others criticize it as a substitute for political activity; it makes us feel as if we are taking control when we are really only withdrawing and leaving the oppressive and unhealthy influences even more firmly in control. Finally, there is the perpetual worry that self-care is only a white, educated, upper-middle class phenomenon and thus benefits only those who need it least, abandoning the less well off.

However, everything depends on how self-care is learned and carried out. The implication, then, is not that we should reject the trend toward self-care, but that we should help channel it in politically fruitful directions. As a first step, I offer a general review of the available self-care literature.

Available Books: Poor and Counter-Productive Types

I cannot review all of the available books individually, since there are a great many of them available and more are constantly coming out. But it may be useful to try to indicate what features are poor and counter-productive in them, and I shall use some present books as examples. (The discussion is restricted to books because they are the only resource generally available; most of what I say, though, can be extended to classes and self-care programs.)

I suggested that self-care could reduce dependence on medical professionals. Some of the available books, though, preserve the mystique of the doctor and professionalized medicine. Self-care seems to be considered simply a way to take the common (and less profitable) treatments off the doctor’s hands. A number of books of the “McCall’s Home Health Guide” variety are open to this criticism. Others concentrate only on self-diagnosis and leave all treatments to the professional; these books might be adequate if supplemented with a good book on treatments, although the best books tend to include both.

Self-care can also help to demystify medicine. But again, certain of the available books fail to do so. Few of the books concentrating on drug therapies, for example, discuss how drugs work. Seldom, moreover, do they explain the testing procedures which led to the therapeutic claims so confidently presented as hard fact. Many rely on data from the drug industry, and few of these books discuss the pros and cons of modern drug therapy as such.

Another kind of approach open to the charge of mystification, I think, is what could be called the “smorgasborg” approach, exemplified, for example, by the Berkeley Holistic Health Center’s Holistic Health Handbook. This book is a catalog of currently popular non-standard medical techniques: acupuncture, American Indian medicine, massage, various “holistic” medicines, and so forth. The objection to such a book is not that it is non-standard; the objection is simply that it does not present any coherent picture of the body and how it works. Nearly every chapter presupposes a quite different paradigm of the body, of illness, and often, of the universe itself. At best one will acquire a number of disconnected techniques that make one “feel good,” without any consistent and generally applicable idea of why. And quite apart from their clash on the theoretical level, many of these techniques work against each other in practice.

Not to be misunderstood: there is certainly room for “survey” books, which present a wide range of alternative ways of seeing health and the body. But these books should focus on general conceptions and not methods. After one has chosen to work within a particular one of these conceptions, then one can turn to methods-with some sense of understanding and consistency.

Finally, there are books objectionable on straight- forward political grounds. Most applicable of all is the “blame-the-victim” criticism. Consider this quote from Samuels’ and Bennett’s The Well Body Book:

When the mind holds ideas such as worry, fear, anger, jealousy, hate, etc., your body manifests these feelings as muscle tension, decreased blood flow, and abnormal hormonal secretions. Eventually these states of consciousness result in disease. In this way people literally create their own diseases…When your mind entertains ideas and feelings of love, joy, peace, harmony, and openness…your body manifests these feelings as relaxation, acceptance, radiance, alertness, and a natural flow of blood, energy, and hormones. This is a healthy state. Through your thoughts and feelings you create your own well body.6

In a time when 70-80% of all cancers have been linked to environmental causes, when drastic and deliberate political and economic pressures are a reality for many and a threat for many more, when workplace safety is being subordinated to increased production and profit, this approach is a cruel deception. But many books are of this sort.

A second political criticism has to do with the idea of “substitute activity.” Certain forms of self-care can be criticized in this way. Techniques which demand two hours a day of special exercises, or expensive and time consuming cooking techniques, may give one a sense of activity while in fact only diverting one’s energies. In any case, health is simply not the only thing of value; its value is primarily instrumental. Simone de Beauvoir is supposed to have reproached Sartre for ruining his health while writing Being and Nothingness; according to the legend, his response was “But what is health for?”

Finally, it is true that most of the presently available self-care books seem to be addressed to a privileged audience. However, this is not necessarily true. Our Bodies, Ourselves shows how effective a self-care approach can be for oppressed groups: how learning self-care techniques is only the other side of recognizing some of the forms of one’s oppression, and how recognizing these forms of oppression is, again, the other side of beginning to learn ways to overcome them. I will return to this at the end of the next section.

Available Books: Better Ones

Several currently available books genuinely help to reduce dependence on the professional medical system and to demystify medicine. Two general books of this sort are the Healthwise Handbook, by Toni Roberts, et at. (Doubleday, 1979) and The People’s Handbook of Medical Care, by Arthur and Frank Sutton (American Book-Stratford Press, 1972).

Healthwise Handbook has its liabilities. It presents its aim as merely to strengthen the “communication and partnership” between patient and health professional. Certain outrageous moral attitudes are presupposed: e.g. that “self-stimulation” is bad. Nonetheless, the main body of the book is a quite clear coverage of common health problems, what their causes are, and how to handle them. Despite the initial bias of the book, the sections on home treatment are quite extensive and adequate, and the points at which calling a professional is recommended generally seem reasonable.

The People’s Handbook of Medical Care is written by two doctors from the Medical Committee for Human Rights. Its sections on common sicknesses and treatments are briefer, but it compensates by wider coverage: it discusses how to evaluate a doctor, deals with medical emergencies like gunshot wounds and stabs, and includes a chapter on “social and political medicine” which discusses drug use, tear gas, etc. At some points it seems to “over-recommend” aspirin and certain antibiotics, but at other points it makes the pointlessness and even danger of drug therapy quite clear.

There are also some excellent books on specific health problem areas. Most important and well-known is the book Our Bodies, Ourselves, already mentioned (published by Simon and Schuster, 1976). Being written “for and by women”, it does not attempt to be a general self-care book. It concentrates on the female sexual cycle and organs, contraception, pregnancy, and so on. Third person, biological discussions are often interspersed with first-person accounts. The authors recognize from the start that the problem is in many ways a political one, that women’s ignorance is not accidental and that “taking control” means not merely acquiring the needed knowledge but also developing the ability to recognize the oppressive forces at work in medicine and the strength to stand up to them. All of this is discussed in detail, often again, interspersed with short first- person narratives. And the book as a whole attempts to be as supportive as possible and to encourage reliance on other women and the women’s support community.

The same group has published two other books, one “for and by parents”, called Ourselves and Our Children, and one dealing with problems of adolescence, called Changing Bodies, Changing Selves. Both books use the interspersed first-and third-person accounts which are so effective in the original book, and both maintain an awareness of the social and political roots of many of the problems discussed. 

Still, much work remains to be done. A general book which combines self-care details with a thorough political understanding, as Our Bodies, Ourselves does for a specific area, is still necessary. Apart from the particular problems with the Roberts, et al. and Sutton books just discussed, those two books affect political awareness at best indirectly. A politically adequate approach to drugs, as well as many other areas is also necessary (and not just a critique but an attempt to come to some sort of reasonable practical conclusions).

Those who can write such material ought to be encouraged to do so. And we ourselves might begin to develop the ability to care for ourselves and for others in these ways, and to try to promote self-care more generally. In the context of a profession which has for so long monopolized such caring, informed human caring can be a revolutionary act.  

>> Back to Vol. 14, No. 1 <<

REFERENCES

  1. Medical Nemesis (NY: Random House, 1976), p. xvi.
  2. Lois Pratt, The significance of the family in medication. Journal o f Comparative Family Studies IV: 1 (spring 1973), p. 13-31; John Kirscht, The health belief model and illness behavior, Health Education Monographs 2(4) (Winter 1974), p. 387-408.
  3. See Lowell Levin, et al. Self Care: Lay Initiatives in Health (NY: Proudist 1979).
  4. Contact address: National Self-Help Clearinghouse, Graduate School and University Center of the City University of New York, 33 West 42nd St., Room 1227, New York, NY 10036.
  5. Levin, op. cit., p. 27 and 42.
  6. (NY: Random House Bookworks, 1973), p. 2.