a matter of time. With each generation the accuracy and resolution of
diagnosis would become more accurate.
This, in part, comes from a rumination on what is schizophrenia. It's
defined by a set of symptoms. That's what it is. The symptoms describe a
type of human being. The use of the paradigm of illness is this type of
individual has a lowered prognosis in life because of, in my opinion, a
malformation in society which decided to call anything apart from
robot-like human beings (automotons is my neologism ;-) ) mentally ill.
The prognosis in mental health mixes with the social model of disability
and says a person will have a worse life, by various measures, because
of who or what they are.
The biomedical model choses to consider schizophrenia an illness but
other paradigms don't. There is no solid scjientific truth to the
biomedical model and much of the evidence can be interpreted in
different ways.
What's clear is there's a lessening of life outcomes, be it life
expectancy or occupational function. This is how the idea of illness can
be applied but it does not mean it is an illness. This is an independent
concept of which illnesses are part of but not all of. Skin colour or
gender or other variables and types of individual can do worse in life.
Psychiatry was formed out of compassion for the outcast, those not fit
for the Industrial Age society which desired robots, not people, so
outcast people on to ships to drift out to sea or pushed them to the
edge of society in other ways. The old leper houses were used to
incarcerate the mentally ill so they could be looked after by a
compassionate society. (And in so doing they redoubled the problem of
normality by hiding the mentally ill from Western society for
generations so people forgot what psychiatric illness was and used the
paradigm for whatever purposes they saw fit, for example pathologising
women who were promiscious. (There may be certain types of people like
that and it may be possible to apply evidence to support the idea that
biology is involved. However the same could be done to consider those
poor souls who are single or engage in monogamous relationships or don't
had enough sex - it just depends who's making the judgements.)
REgardless, a practical way to see what are the recordable factors and
patterns within those factors which mean a person will experience a
poorer life would be a fascinating study.
I'll skip the rest of the preamble and jump to the idea. It starts with
census-level data. Everyone must be counted. Then it takes getting as
much information as possible together. Then it's simply a case of
letting a computer process the data over a number of years of data.
It's sort of already done at the moment in a very basic way and
influences government policy. The data from the UK's census provides a
vital data source for showing how things have changed for people. It and
other data is used to show how certain areas have significantly higher
life expectancy than other areas.
The UK still lags behind in the detail and frequency of recording. I
think it's the Swedish or one of the other Scandianvian countries who
are totally mad for population data. So many studies use data from
Sweden because there's so much of it.
Linking the census with mental and physical health questionaires would
provide a signifacnt amount of information to better understand the
factors behind the mortality gap between worst and best. A higher
frequency would also provide much higher resolution (a more frequent
census would make the science which uses the data more accurate).
Most of all it could make government policy better focused on objective
outcomes. This shift to the philosophy of evidence for decisions has
been accelerating in pace outside science. The Tableau bu Bord and the
Balanced Scorecard approach are two examples. The Bhutanese measure of
Gross Domestic Happiness is another.
For science and evidence-based politics this sort of study would be
priceless. For healthcare it could also be significant. The outcomes of
mental illness (the people who fit the cluster of symptoms) may be
matched by other people who, for example, live in deprived areas or is a
first generation immigrant.
Whether working to resolve the dysfunction which causes the disability
in the sense that a person does worse in life is something which should
be dealt with by doctors is another question and perhaps far deeper. My
instant reaction is to think the use of the medical paradigm and
profession to treat mental 'illness' (which I don't see as a true by
what illness was traditionally defined) would engender more mistakes in
society. It takes a new breed.
I might just be thinking of sociologists but I'm thinking more like
society doctors. People who seek to find the cause of the social
disability which creates the prognosis of any phenotype.
Perhaps in a few hundred years there might be a Royal College of Society
Doctors. They'd probably have the same motto as the Royal College of
Psychiatry does now. Let wisdom guide.
They'd fucking need it. For 200 years psychiatry has just treated the
individual. It's through society-changing campaigns that there has been
a small amount of real healing of the problems of mental health.
Fuck? Perhaps I'm not talking about sociologists as society's doctors.
Perhaps I'm thinking about activists and campaigners.
Fuck. Who knows. I'm tired. And not drunk. There's no wisdom in that.
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