EPA-1443 - All Psychiatry is Social

Abstract

Medicine as a discipline cannot function in a social or cultural vacuum. Culture and society determine what is pathological or deviant and where help is sought from. Society and cultures also determine child rearing patterns and cognitive schema as well as the way we learn to look at the world-developing our world view whether that is related to medicine or society as a whole. The reductionist view in medicine is that medicine as a discipline relies on biological factors. However, it is often ignored that biology itself is affected by social and cultural factors including diet, attachment patterns, use of substances etc. Society dictates the type of medicine being practised and the resources that are made available. It is the members of society directly or through stakeholders who determine what sources are needed for training of health care professionals across all medical disciplines. In addition, especially in psychiatry, the society will determine and dictate deviance and how deviance is to be dealt with along with what is seen as risk behaviour and who determines the severity and who deals with it. The concept of the social contract originally between the monarchs and their subjects dates back centuries and is simulated between physicians and society as a whole. However this is implicit and not explicit and is negotiated between the stakeholders and the health care professionals. Stakeholders also determine and dictate how the professions are regulated. It is the regulatory bodies to whom the physicians answer regarding their clinical practice and standards of health care delivery. Certain aspects of clinical medicine will always be social and be very strongly influenced by prevalent social factors. These can be applied to causative or contributory factors as well as in the intervention and management strategies. Furthermore, for certain psychiatric conditions cultures and societies play a major role in moulding the symptoms, identifying idioms of distress and defining illness and sickness behaviours. This action is social and dictates what is seen as normal and what is seen as abnormal.