Patient is the Opposite of Agent
By Laura Rathbone
I realise that this may come as a shock, but I am still un-picking my reductionism. Reading this month’s reading has brought me closer to recognising some of the more deeply held and subtle reductist-tendancies. But I’m not angry at myself, nor do I feel bad about it. I’m human and have been socialised from birth to believe that all of a persons problems can be solved by breaking it down into parts and working to fix the parts separately so that the problem will magically go away.
I was taught to live like this, study like this, find love like this, to plan my future like this, to understand and improve my own health like this and of course, to create therapy spaces for others like this.
It’s literally breaking the habit of a lifetime (so far).
The Cause Health chapter Elena Rocca and Rani Lil Anjum, two philosophers and women whose work I respect enormously, is the gift that keeps on giving. Every read brings into deep observation and contemplation of myself, my role and the wider healthcare profession.
This chapter opens by supporting us as readers and clinicians to recognise and criticise the biomedical model and philosophy of health and healthcare. This is important and reflects what I’ve noticed about my own training and other clinicians, is that we simply don’t fully understand what the biomedical philosophy and model of health and healthcare actually is. This makes identifying it in the research, our bias and the practice of others tricky.
The authors cite a quote from Steven Tyreman “The opposite of ‘patient’ is ‘agent’, and a loss of agency is experienced as illness.”
We talk a lot about agency in healthcare training, but in practice, it is culturally normal for us to operate in paternalistic models. The words we use are in-congruent with our actions and I think this brings about a great deal of conflict, within ourselves and within the person accessing healthcare. People hold huge amounts of knowledge about their world, their body and their needs which can help us to formulate and understand not only the challenges to recovery, but why they might be struggling in the first place.
I remember one of the first essays I wrote as a sixteen year old interested in communications, was on health promotion and public understanding of health. How do we communicate that health is a combined physical, psychological and social state of wellness? And are we modelling that in the design of our systems?
I’m not convinced that the therapy space should look anything at all like a hospital or medical centre. Therapy is about people, families, lovers, friends, colleagues, neighbours and strangers. It’s about being able to manipulate and interact with the environment and technology around you so as to better be able to connect and live with those people.
Pain care demands this of us and our professions. It insists that we must work to the person, not the other way around. This brings us up against the restrictive boundaries of the healthcare system as it operates and requires us to have the strength in out ethics and principles to withstand the squeeze.
Rocca, E., & Anjum, R. L. (2020). Complexity, reductionism and the biomedical model. In Rethinking Causality, Complexity and Evidence for the Unique Patient: A CauseHealth Resource for Healthcare Professionals and the Clinical Encounter (pp. 75–94). Springer International Publishing.