Following historian and philosopher Hanna Arendt, there is the belief that the public should assert their needs and interests in scientific endeavors.1 But, before the public can weigh in, someone must fully inform them of the issue involved. Once citizens understand a problem, they can ensure, through their political representatives, that the science aligns with their demands and does not go off on its own. For example, once Americans understood the gravity, they clearly articulated that they would not allow science to create human beings in a laboratory or have computers governing the world.
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HSCirkel.sgg: Jsdo 1980: Represents Lithium-7. Black dots are electrons, red dots are protons and blue dots are neutrons.
Source: CC-BY-SA-3.0
In contrast, modern medicine illustrates what happens when the public lacks information and has little input: educators and researchers go on their own—and continue to do so in the face of abject failure. Here is one example in medicine, US citizens do not know how frightful their mental health care is, that medicine refuses to adopt the teaching that would cure it, or that they can direct their politicians to require that change.
What do Americans need to know to activate and direct change?
1. Although mental illness is the most common health condition in the US (nearly 100 million Americans in any one year), most people do not know that only 25 percent of patients receive any care, most of which does not meet standards. Compare this to 70 percent of physical disease patients receiving care of high quality. Mistakenly, some uninformed Americans even assume mental health care matches medical care.
2. Few realize that compromised mental health care results from two easily remediable medical derelictions: a) medicine fails to train enough mental health professionals (psychiatrists and psychologists each conduct only 12 percent of care); and b) it provides almost no training for the primary care clinicians who, by default, conduct over 75 percent of mental health care; their lack of training explains why most mental health care is substandard. Shockingly, educators devote only 2 percent of physicians’ training to mental health care. These facts identify the simple but surprisingly overlooked solution to the mental health crisis: train more mental health professionals and train the medical doctors who provide most of the care.
3. Almost no one understands why medicine would resist such obvious solutions. The “mind-body split” philosophy or theory developed in the sixteenth and seventeenth centuries caused this blind spot. In a political compromise, church and science leaders of the scientific revolution agreed to the split: the mind, soul, and spirit went together and were the church’s province alone. Medicine could only consider the physical body and its diseases from the neck down. That made mental disorders and other mind issues, such as emotions, off base for medicine. Although mental health care became medicine’s responsibility in the 1800s, physicians have never deviated from their isolated focus on the physical body and its diseases. Only a small minority of clinicians ever showed any interest in mental health, and the tiny field of psychiatry formed around them; this was often disdained and dismissed by the majority culture. Sadly, medical education has never exhibited an interest in mental illness training for medical students or producing enough residencies to train psychiatrists. On the other hand, medicine has not failed. The mind-body split led to massive physical healthcare improvements in the last century when life survival doubled from 40 years to 80 years.
Diliff: A panorama of a research room taken at the New York Public Library
Source: CC-BY-2.5
Nevertheless, the exclusion of a patient’s psychological and social life now renders the mind-body split obsolete. It worked primarily for the acute physical and surgical illnesses that medicine has now cured or controlled for the most part (for example, tuberculosis, pneumonia, diarrhea, diphtheria, tetanus, and whooping cough; and ether anesthesia). But modern medicine’s patient population has changed—mental illnesses and chronic physical diseases are the most common conditions practitioners face.
Although it’s obvious why eschewing the mind shortchanges mental illnesses, almost no one recognizes it is also harming chronic disease care. Most chronic physical disorders are caused by the very psychological and social factors excluded by medical education—lifestyle issues such as cigarette smoking, alcohol abuse, overeating and overweight, drug addiction, and stress. Doctors must incorporate lifestyle issues into treatment to improve the underlying physical disease, such as heart disease, cancer, or diabetes, yet they are not taught how to do this. More incriminating, medicine could prevent some 80 percent of heart disease and diabetes and 40 percent of cancers by addressing lifestyle factors. But it waits for cancer and heart disease to occur and then treats the problem.
4. Although most people think medical education and research are scientifically based, the public will no doubt be aghast to learn that it does not follow modern scientific principles. Among all sciences, only medicine does not adhere to modern scientific theory: a systems view of life—where physicians and other scientists must consider all parts of a problem and their interactions.2 Medicine’s isolated disease focus omits the equally important psychological and social parts of its patients. More disturbing, medicine ignores the systems approach proposed for it in the 1970s, the biopsychosocial model. Demonstrably superior and research-based, the model links the patient’s physical disease (biological) features with their psychological and social parts, thus integrating mental health care with medical care. Actively teaching the model would guarantee that the quality of mental health care matched physical disease care. Yet four centuries of “brainwashing” by a now effete theoretical concept has left physicians immune to recognizing its profound shortcomings.
Exactly how do we initiate change? Inform the public. Typically, after citizens are informed and angry, they direct their politicians to confront refractory institutions. People knew little, for example, about the risks of automobiles and chemical pollutants. Then came Unsafe at Any Speed by Ralph Nader3 and Silent Spring by Rachel Carson.4 These books made millions of Americans aware that seat belts saved lives and that we had poisonous DDT in our drinking water—but that the auto and chemical industries refused to install seat belts and remove DDT for financial reasons. An irate US population insisted on change. That’s why you have seat belts and clean water today. And a model for change—informing the public.
