The collapse of narratives

Salvador Casado

The systemic crisis that we are experiencing sets the stage for the current collapse of civilization. It is characterized by a globalization of unrest and fear that diminishes thought, reflection and understanding. We find nothing to hold on to, no leaders, no ideas, no narratives, which is allowing power to position itself behind technologies that offer rough substitutes.

Foto: @famani38

This situation of complexity affects all social areas from politics to education, from labour organisation to health. I will focus on the latter, which is the one I know best.

For years, health professionals have been aware of the collapse of public National Health Systems in different countries. We know the causes but we do not have the capacity to implement solutions. We think that with changes in organization, financing and management it would be possible to change and improve the system. We are frustrated that there is no political or managerial motivation for this and that there is not enough energy or will on our part.

Perhaps society is taking the wrong approach. In my opinion there is no health organisation that can resist the current social situation that has turned health into yet another economic good and has established the laws of the market as lex artis. The citizen will always want to consume "more health", and when faced with any symptom she will ask for solutions.

We have lost the battle of the narrative by assuming as true for the field of health the market paradigm that prevails in our time. By defining health as well-being we open the door to the generation of infinite goods and services susceptible to commodification. The patient becomes a consumer and as such asks to be treated. It is not surprising that overdiagnosis and overtreatment are the black angels that arise from this perversion, children of the health abuse that characterizes this generation.

The citizen's dependence on the health system is increasing. Regardless of age and personal circumstances, the slightest symptom leads to a visit to a health centre. We have clearly failed to empower the patient after years of good samaritan health care in which any type of consultation has been assumed to be legal and everything that came through the door has been attended to. And this has a difficult return.

But how to transform this narrative of health, how to help those in need to get a new perspective on what is happening to them? The answers lie in favouring quality communication that allows a relationship of trust between patients and professionals. The second thing will be to learn to listen to what lies beneath the reason for the consultation, to manage to visualise the person as a whole. Dare to see its four quadrants: physical, psychological, social and existential. The third thing will be to be able to accompany the patient in the construction of a new narrative that allows him/her to take charge of what is happening to him/her, to accept it, to sustain it and to continue walking. Healing implies that everyone completes this internal process regardless of what happens to their symptoms.

Many will wonder how this will be possible in five or six minute consultations in increasingly overloaded schedules. And to this I respond with another proposal for a change of narrative, in this case for professionals. If we continue to focus on complaint and limitation we will not be able to realize the enormous power that clinicians have to help their patients transform the lead in their lives into the longed-for gold of serenity, existential sense and joy. Alchemy is always done by the sufferer, but what good is a little external help when one is in the middle of a dark night.


@doctorCasado

Link to blog "La consulta del Doctor Casado"