Expanding Niche in Health Care

• Welcome to the BOL Forum on Evolutionary Psychology by John Grohol, 3/19/97
  • About Evolutionary Psychology by Behavior OnLine Editor, 12/28/96
    
    

The "Harvard Mental Health Letter" (October, 1997, 14(4), pp. 5-7) has an article on Psychiatry and Assisted Suicide. Block & Billings describe a scenario in which an oncologist wants a second opinion about a woman's request for help in dying. She has metastatic breast cancer. The psychiatrist is asked to consult, there is a list of questions and issues in determining competency.

Our values appear to follow economic pressures. There were/are hospital committees to assure that every step was taken to prevent a patient's death. Similar committees evolved to issue consent, in the absence of families, for the termination of life support. Now the team is getting smaller.

Will this stay a medical domain? Will my professional, nonmedical peers lobby to occupy this new niche? Psychologists cannot prescribe in order to promote health, will we be eventually enlisted in institutions to meet this growing market? Can you go to Heaven without a social worker? Will an HMO pay for the consult?

I regret being cynical; but I've seen it before as economic pressures sharply changed our services in mental health. Applying a similar logic means that, as the population of older Americans increases (a population increase that is unknown in prior geological time) and fewer agencies can fund long term nursing and fewer of us oldsters want to give our assets to the healers instead of to our children, costs and barriers to our timely removal will themselves be removed.

Thus, expect certification to develop in this new specialty. Expect various mailings from workshop providers. (Some sharpie is already working on this one. The themes will shift from funereal compassion about the changing landscape to how-to-do-it-in-three-sessions. Should take about 4 years!) Expect patent-protection and price inflation on the effective chemicals (does the word medicine still apply?), and eventual generic formulations (less effective than the brand name?) followed by over-the-counter preparations.

These dilemmas arise from our being so good at holding off the bugs that are our best predators. Many of us used to die by age 18 or in childbirth. We still dispatch physicians across the globe to help everyone live longer but cannot manage the bounty. We incur other costs instead.

Old age can be a time of incredible peace and emotional richness. We have much to contribute to the rearing of our grandchildren, provided they didn't move to California and we still get to see them. Yet, there's a time to call it quits, to take our own walk into the tall grass and lie down to return to Earth. We've generally opted as a species for control in preference to random fate. Many of us will prefer a modern hemlock to auto exhaust or a cancer rampage.

NOTES:

a) The church has been of little help. It teaches the peace of heaven, perhaps an opiate heritage from medieval times when heaven was the cookie needed to get people to stack rocks into cathedrals, yet does everything to keep us alive and ineligible for Heaven. Their missionary conflict of interest is apparent. Produce more believers and keep them alive to wall out competitive creeds. (I mind less because I strongly dislike some of the competition; I want them to be honest about their goals and to recognize the population costs of their actions!)

b) I'm not annoyed by my own mortality. And, I'm not surprised that a lot of us are accumulating in various holding patterns in health care; the statistical data are clear that "something will have to be done." It really bugs me, however, that a gang of people are going to make money off of this when their contribution is absolutely gratuitous. The notion of an "honest living," perhaps from operating "Lucinda's Lay Away," where the customer picks the music, the company they want, the movie, and the paint on the wall, is acceptable and possibly inevitable. Some hustler will think of the option and I will admire their enterprise. But, I'm outraged by having to go through a parasitic MH type in order to get past the door. When I'm ready to go, I will deck the first social worker who tries to meddle. (Granddad strikes! I remember my father, enroute to a valve replacement, shaking his fist at me and shouting, "Damn psychologists, making a living off other people's misfortunes." I laughed, the surgical team raised their brows may have wished they gave him less Xanax. He lived another dozen years, dying l8 months ago. I guess Dawkins is right. Pieces of the old man are still around.)

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