…and divided we fall

William House, Retired GP; Chair of the BHMA

Published in JHH15.1 – Transformative innovation in healthcare

For as long as I can remember I have been interested in how the things of the world work. I remember taking my toys apart, spreading the bits across the floor, and then putting them back together again. As I grew older the toys got bigger, culminating with the purchase for £2 of a 1931 Austin 7 car when I was 14. Of course, I took it apart and put it back together – several times – and had fun driving it around the field at the back of our house. Three years later (fresh from passing my driving test) I was interviewed by a consultant surgeon for a place at medical school. I told him all about the car and I was offered a place. The places were hard to get and, of course, his interest in the car told me that taking things to pieces must be the ideal preparation for a medical career! There was nothing in my six years of medical education that prompted me to think otherwise.

So, as a newly qualified doctor in 1972 I was plunged into the world of very sick people. Without conscious awareness, my perspective gradually changed over the next 10 to 15 years. Scientific medicine was losing its fascination. I could see that treating sick people as if they were toys or motor vehicles to be dismantled and reassembled often missed the essence of their sickness. But the challenge was (and still is) to develop the compelling holistic concepts and language that makes sense of the deeper human search for meaning, connection and belonging. This is the essential counterweight to the ‘mechanical fault’ model of illness. This was the founding purpose of the BHMA in 1983 and so it remains.

But, there is a bigger story. Without this our ‘compelling holistic concepts and language’ are unlikely to find their proper place at the heart of healthcare. In 2002, Canadian medical sociologist Arthur W Frank contributed the opening chapter to Consuming Health – The commodification of health care. As the name suggests, this book is about the interface of healthcare with the ‘political-economic orthodoxy of neoliberalism’ – what he calls the ‘high-intensity market’. Using cosmetic surgery as an obvious example, Frank argues that we now consume healthcare in much the same way that we consume any other ‘commodity’ – clothes, cars, meals out, holidays. Of course, this book was published 16 years ago and ‘medical consumerism’ is now not only well recognised but is even more deeply entrenched in mainstream healthcare. ‘Health’ has become a commodity, from over-the-counter purchases such as gym membership, a deep tan from a tropical island or high street salon, to medically contrived treatments – a different shaped nose, different sized breasts. More worryingly, this merges into pills for obesity, pills for depression, pills for high blood pressure.

Frank then electrifies his argument with the revelation of fragmentation as the unifying feature of commodification. This calls into question some central tenets of our culture, and at the same time points towards solutions. Frank describes how health opportunities always offer a solution to particular ‘features’ of the human experience – needing to feel good about yourself, having your desired body shape, being happy, having a ‘normal’ blood pressure, a lower cholesterol. It is never about the entirety of you as a person with your own unique character, strengths and ambitions.

Why has this fragmentation happened and does it matter? I suggest we have an unholy trinity: the economy’s need for saleable products, the scientist’s need for measurements of the human condition and the medic’s need for diagnoses. They combine to sacrifice our own unique reality, replacing it with the bits that will feed the neoliberal machine. This matters because it subverts our deeper human needs, suppresses the idea of the common good and medicalises society – the DSM-5, the latest (2013) list of mental health diagnoses, runs to 947 pages and more than 300 maladies]. Fortunately, some of the many individuals who have realised all this have contributed to this issue of our journal.

I still have the Austin 7. It is no longer a collection of parts, but a treasured possession that carries meaning and connection to memories: of my first date with my wife, Poppy, when she accidently switched off the petrol with her foot; of driving her from London to Hastings and back for a drink; of doing more good for my older male patients than most of my medical ministrations. Just turning up in that car was enough!


  • Frank, Arthur W (2002) What’s wrong with medical consumerism? In: Henderson S and Petersen A (eds) Consuming Health – The commodification of health care. London: Routledge, pp13–30.