Politically correct—or just plain kooky?
BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7300.0 (Published 16 June 2001) Cite this as: BMJ 2001;322:0
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I was interested to read the final paragraph of the editorial in this
weeks BMJ about the power of words to teach something important.
I am currently analysing in-depth interviews with a number of people
who have become aphasic as a result of neurological episodes. I was
struck when reading the following section that Doctors (like so many us
health care professionals) are in a dilemmma about what to say to someone
who finds themselves with a newly acquired impairment such as aphasia.
Should we be honest at the risk of being brutally honest, should we offer
words of hope, when we suspect that the situation does not in fact look at
all hopeful? Here is what the aphasic people I spoke to had to say.
MALE VOICE. "Didn’t do very much at the beginning, didn’t do
anything. In fact the doctor... I think he said {indistinct} he don’t do
anything... {indistinct} is goodbye. They said bye. Bastards. Of course
that was really {indistinct}."
Interviewer "Did that make you feel very angry?"
MALE VOICE. "I felt very angry. Initially I felt they weren’t
thinking about my {indistinct} I don’t know why they’re doing this… what a
stupid thing to say that I’m not. Because you know every one... strange
that she said that..."
Interviewer "So were you saying that it was silly of the doctor to
say that because each person is an individual."
MALE VOICE. "Recently I am of that thought. I can’t believe her like
that, it’s incredible. As if I was just gonna do nothing, that’s
terrible."
MALE VOICEII. "The doctor who came to see me in the hospital has
erm... another way of putting it. He said to me I can be back at work in
two months time."
MALE VOICE. "Two months time."
Interviewer "And?"
MALE VOICEII. "Wrong again. If I can... 14 months I can’t go back to
work."
Interviewer "How did it feel when he told you that at the beginning."
MALE VOICEII. "Erm... very good."
Interviewer "Yeah. Did you believe him?"
MALE VOICEII. "Yes."
Interviewer "And what happened when it got to 4 months and you still
weren’t back?"
MALE VOICEII. "I wanted to ring his neck."
Interviewer "What do you think he should have said?"
MALE VOICEII. "Erm this is a long job... have erm... this a long job
and if we can see you erm... in a months time and we can make a decision
then."
The text, I think, demonstrates a number of points.
1. Aphasic people, like many patients, have strong faith in every word the
doctor utters.
2. Each aphasic person is different and no-one can yet predict who will
make significant functional recovery and who will not. Frequently those
left with mild aphasia are the ones with significant handicap.
3. Realistic information is needed. Aphasia is usually a chronic
condition and introducing that idea, gently, when discussing prognosis is
important. False hope can be as devastating as no hope.
4. Just because YOU can't do something for someone, doesn't mean nothing
can be done. As with so much neurological illness, the impairment may
remain, but the disabilities and handicap associated with it can be
reduced. The improvement seen is not necessarily during the post-stroke
stay in hospital, and may be facilitated by other health and social care
workers, families and friends.
5. Aphasic people can offer us quidance with such dilemmas.
The messages in the text are neither new nor exclusive to people with
aphasia. However, I have deliberately chosen to leave the text unabridged
so that the aphasic people were speaking for themselves, when reiterating
some important lessons for all of us about respecting patients.
Competing interests: No competing interests
Whilst there are undoubtedly many unfounded claims made by the
advocates of complimentary treatments, Roger Fisken (1) is wrong to assume
that Professor Jean Marie Charcot had no association with what is
described as alternative medicine and would be 'revolving at high speed in
his last resting place.'
Charcot in fact had a great interest in
hypnosis, dissociation and hysterical mechanisms and his work provided the
foundations for the development of modern clinical hypnotherapy. Whilst
claims for the benfits of hypnosis should be modest and only a small
percentage of the population is highly suggestible, I suspect Charcot
might have been rather pleased that hypnosis continues to be practiced and
can be freely downloaded from www.magictrance.co.uk
Jason Taylor
Consultant Psychiatrist
Warley Hospital, Warley Hill, Brentwood, Essex CM14 5HQ
1. Fisken, R Road to betrayal is short BMJ 2001;322: 1486 (16 June)
Competing interests JT is the developer of the magictrance website
offering free computer videoclip hypnotherapy downloads.
Competing interests: No competing interests
As Editor you have chosen an amused, detached, umpire-like tone
whilst reviewing the strong reaction to your own choice of editorial line
on two important contemporary issues; scientific medicine's attitude to
unscientific medicine and whether or not it is legitimate to attempt to
steer public attitudes by the banning of certain words.
In both cases it is not for you to tell us that the arguments are
evenly balanced and that we can all derive entertainment from the lively
debate in your rapid response columns. The plain truth is that for a
scientific journal both issues are matters of principle and in both cases
the line you have chosen is wrong.
Competing interests: No competing interests
Having read "Politically correct - or just plain kooky?"
and David St George's previous rapid response "Integrated medicine means
doctors will be in charge" quoted, I believe the statement in the former
to which A. G. Hocken objects, which begins "But his is only one voice in
a correspondence ...", is correct. Hocken correctly reproduces the
quotation marks himself. How can the BMJ be accused of political
correctness for correctly reproducing the views of its readers? The view
expressed by St George is perhaps not surprising, given his affiliation.
John Walsh is probably further amused (or irritated) to note that the
two editor's (previously grocer's) apostrophes were deliberately
introduced by BMJ in (mis) quoting the sentence of St George.
Competing interests: No competing interests
The passage below, which I have copied from the text of "Politically
correct or just plain kooky" is a magnificent example of the contrived
perversity of the "PC" school, which will never allow anyone to be right.
I believe the saying is that one cannot do right for doing wrong! And such
opinionators expect to be taken seriously!
" ...in a correspondence that also sees the theme issue as "orthodox
medicine's attempt to shore up it's monopoly" by bringing complementary
medicine under it's wing."
Competing interests: No competing interests
Political correctness is only slightly more irritating than incorrect
spelling by those whose trade is writing. The use of "it's" instead of
"its" to mean "belonging to it" (which occurs twice in the article) used
to be called the grocer's apostrophe. In these politically correct times,
this slur on the petit bourgeois should be avoided, and it should be
renamed the sub-editor's (or editor's?) apostrophe.
Competing interests: No competing interests
Scientific investigation of Kookiness
I was fascinated by Roger Fisken's letter and have an enormous amount
of sympathy for his view. However, he must remember that the search for
scientific proof is not what keeps medicine apart from complementary
therapies.
There are many complementary therapies that have been validated
by science and equally many that haven't. There are therapies that have
been part of traditional medicine for many thousands of years and have
never been scientifically validated because the users saw no need to prove
scientifically what they knew had worked. Scientific proof has only arisen
as a validation for trying something that was new and nobody knew if it
would work or not. Science has validated somebody's new theory not what
has been a part of treatment regimens for as long as the practitioners
could remember. There are many practices undertaken by allied health
practitioners that have their basis in well founded research but are
rejected by the mainstream medical practitioner because they are not
exclusively the province of the registered medico.
I am currently doing a
Ph.D. research project that seeks to identify what is the reasoning behind
treatment choices, complementary versus mainstream medical and the results
are providing me with some very interesting reading.
Competing interests: No competing interests