Teaser from my latest CFN column...
“Is there a lot of controversy around diagnosis? Absolutely. Should there be? Absolutely. That is its greatest virtue. It provides opportunity for input from lay people, social workers, and brings us all to the table. We’re dealing with conditions where there is a profound degree of complexity and a profound degree of uncertainty.”
There's an old joke about a patient who goes to see his doctor about a physical complaint. The injury itself doesn't matter - let's say it's typing too much on a blackberry, just for fun.
Patient: "Hey doctor, it hurts when I do this."
Doctor: "So, don't do that."
Of course, that's not the way it tends to work out in real life, is it? An actual conversation with one's doctor might go like this.
Patient: "Hey doctor, my thumbs are killing me, it hurts to type. You gotta do something."
Doctor: "Have you tried typing less?"
Patient: "Drop the lip, doc - I pay you to fix my problems, so fix this. I've got a report that's due next week and the pain is getting in the way. Can't you give me some Oxycodone or something to help me get back to work?"
Ouch. No rim shot for that one.
Our healthcare delivery model has changed course over the last century or so into one that’s consumer-based – health is a service provided, not a lifestyle. Work, not health, is the focus; instead of trying to improve and sustain health, our medical professionals are being seen more like pit crews. How quickly can you patch up the patient and get them back into the rat race?
Our social/economic model of society is very much a race - competition grows ever steeper and people need to invest more and more of themselves, their time, even their well-being into keeping from falling behind. If you don't have access to the best parts and pit crew, the odds are really stacked against you ever winning. The success of the system comes first - individual benefit is supposed to be an organic byproduct of the free market.
First Nations people and their insistence on group think and non-Western social customs? That's a problem that needs to be fixed. Lefties who can't seem to get things done with the tools they're provided? They need to operate from the right if they want to belong. Women who disrupt the work cycle to have babies and such? Not a good investment in the first place.
See the pattern?
We might like to tell ourselves we're inclusive and really open to supporting people's differences, but when we rest on that opinion, we're deluding ourselves. More often than we realize, we're not accommodating the specific challenges of a person - we're trying to get them to conform. Even Free Market purists trying to save welfare-state believers from themselves are trying to fix people they see as misguided.
About two years ago I had a chat with a former boss, Leslie Noble (a senior Conservative advisor and Government Relations expert) about top-down management. She was frustrated on behalf of a friend who was Executive Director of a mental health institution. Thanks to a standardized government mandate, the friend was being expected to dedicate allocated funds to solving one problem, when it was a different structural issue that was really threatening her operations. This, Leslie explained to me, was why she is so dead-set against a top-down standardized approach to fund allocation; it stifles people from doing what they need to succeed.
I bring up madness intentionally, because there's a strong correlation between manic genius and diagnoses of “crazy” - look at this list of famous people with mental illness for just a few examples. Do you know any geniuses yourself? Do you find them a bit high-functioning, maybe have or had substance abuse issues or personal relationship challenges? It's surprising just how much staff of high-performers serve a bit like counselors and support workers, helping to keep the genius focused and keep the individual from going off the rails. If you've ever worked in politics, you'll have seen this, a lot.