The NHS is far too good at creating patients.

The NHS is far too good at creating patients.   It is supported in this by the market which creates supply-led demand that results in disorders of excess, for example obesity and diabetes; and in addiction, for example to alcohol and gambling.  It does it through the invention of illness, such as ADHD and its variants, or the stretching of illness through the promotion of elastic conditions such as bi-polar affective disorder, Alzheimer’s Disease and post-traumatic stress disorder.

Once the newer forms acquire currency and treatments for them, which are often of questionable value, are created, a second wave of approaches develops – in the form of early intervention and prevention.  The research, pharmaceutical and lobbying industries gather round, legitimised by influential charitable pressure-groups, and a speculative construct quickly becomes a familiar cultural and medical landmark.  Quite early on in this process a tipping-point is reached, beyond which to question the project is seen as being reactionary and hostile, and perversely in favour of suffering.

Royal Colleges and high-status specialists and Trusts are in the vanguard of this movement, as can be seen in the reaction to data produced recently by the Office for National Statistics which are said to show that as people get older they tend to drink alcohol more often, seven times as many men and twelve times as many women over 65 drinking almost every day as those aged between 16 and 24.  One of the authors of a Royal College of Psychiatrists report called “Our Invisible Addicts” (June 2011) is quoted in the Independent as saying in response to these figures: “this is such a hidden problem – older people drink behind closed doors. There are a variety of problems but they are usually below the radar because they do not involve death or liver disease”.  The report itself suggested that life-events such as retirement or bereavement tend to lie behind this habitual use of alcohol.

This is a spectacular demonstration of clinical colonisation using language with a transforming deftness of which the most highly paid advertising copywriters would be justifiably proud.  Older people who perhaps drink more than is wise are characterised, not just as hidden addicts but as “our” addicts.  Thus they are no longer autonomous and individuated but belong in some strange way to the clinical community.  Drinking, perhaps with friends, in the comfort and quiet of their own homes to save a great deal of cash is converted into a furtive activity in the same bracket as domestic violence or child abuse. 

Facts become problems and culturally unexceptional behaviour with the aim of mitigating the normal losses of this phase of life is branded as habitual and by implication pathological.  Most culpable and wilful of all, it is carried out beyond the sweeping radar of the forces of the State, benignly arrayed to save us from ourselves – at least for now, since their penetration into the private sphere has an irresistible momentum.

We are all patients now. Our peccadilloes are healthcrimes, our touching efforts to smooth the hard edges of our lives of quiet desperation suitable targets for treatment. To be normal is to be sick because to be sick is to be a customer.