| Family Matters by John Illman | | Print | |
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Family Matters By John Illman
Review of ‘Being Me and Also Us: Lessons from the Peckham Experiment’ by Allison Stallibrass.
Could family therapy hold the key to preventive medicine? The term ‘family doctor’ is a misnomer. The family doctor, the bedrock of the NHS, rarely treats families as such. Although illnesses occur within families, and may be triggered by interactions within them, his primary concern is with the individual ‘patient’ – the ‘sick’, individual patient.
This might have been appropriate in Hippocrates’ time when the world was not plagued by degenerative conditions such as coronary heart disease. But is it appropriate now? Should ‘family doctors’ consult with the whole family to promote positive health? The idea, of course, of being confronted in the surgery by Mum, Dad, Jason and Sharon will make many doctors reach for the prescription pad in pursuit of tranquillity. They may perceive it as a waste of time or, at best, something better done by someone else. Conversely, Dad may ask what on earth he was doing at the doctor’s when he was perfectly well. Such thinking is widespread – a reflection of the fact that the NHS is widely regarded as a National Sickness Service. Health has become synonymous with ill-health. But all this could change with a proposed new study. Bringing together family doctors in 15 towns in England and Scotland, it involves counselling whole families about heart disease. Southampton University consultant cardiologist Dr David Wood believes that partners of individuals at high risk may hold the key to persuading them to lead a healthy lifestyle. At the start of the study men aged between 40 and 59 and their partners will be given a risk score, based on their known risk factors – such as high blood pressure, obesity, smoking etc. Dr Wood believes that if families are shown how they fare on a ‘ladder of risk’ score, they will be more likely to understand the significance of ‘risk factors’ – and react accordingly. The study is believed to be one of the first to incorporate preventive medicine with family therapy. At present family therapy is largely restricted to mental illness and social problems. In this therapy, the sufferer is seen as a member of a network of people, and, most importantly, as a part of his family. The emphasis is on how family relationships and communication affect everyone. Therapists believe that considering the individual in isolation might be to miss much of the problem and the means of resolving it. Similarly, with physical illness a person’s health can never be assessed independently of his social and physical environment. For example, the coronary heart disease epidemic is almost exclusively a 20th century phenomenon. Diet is one of the many risk factors linked with it. The modern diet is high in fat, sugar and salt, and low in fibre – the converse of that of our ancestors. Research should show if simple points like these make more impression on a family than on an at-risk individual who may want to deny that he is vulnerable. This will be more difficult if the family hears the doctor’s advice at first hand. But why restrict the concept of ‘family therapy’ in general practice to families? Why not extend it to entire communities to give a new, much needed, preventive dimension to community care? Would it not help to promote positive health? Communities going down this path would discover that good health is not something which the medical profession can give us. The doctors can only point us in the right direction. The responsibility for our health lies firstly with ourselves and secondly with anyone with influence over our environment – law-makers, administrators, planners, architects, teachers, farmers, processors of foodstuffs – and, most important, parents. The idea of incorporating a community centre within a ‘health centre’ may sound Utopian – especially if, for good measure, it were to include a gym, a swimming pool, a dance floor, and play areas for children. It may also sound revolutionary. But, as Mary Midgley’s article explains, it actually happened 50 years ago in South London. Pioneers from this great social experiment, together with the many they inspire today, are convinced that it could work again. It was all about what we now call self-help groups. Today self-help groups are committed to helping people with specific problems. They have been one of the astonishing success stories in health care over the last 20 years. There is no reason why self-help groups dedicated to preventive medicine should not be just as successful. Peckham is the proof. Review of ‘Being Me and Also Us: Lessons from the Peckham Experiment’ by Allison Stallibrass.
This article first printed in The Guardian 1st December 1990 |