Ideas about these stroll in and out of fashion and common sense: in one era they may be treated as questions of folk remedy, while in another considered fit only for highly professionalised advice. If these questions were really so simple, they would have been answered once and for all centuries ago, so crucial are they to human health and the prevention of disease. Accordingly, these six areas of human life should form the core of good medical practice and not as an optional appendix.
What is missing from the list is a sense of urgency: the four drives (to be discussed in sections 12 and 13) are more than a list of good things to do for our health:
to sleep, to drink, to eat, to meet.
Our survival let alone our vitality depends upon them and probably in this order: without restorative sleep we will be unable to retain a disease-free life; without the first aid of water we can barely survive a day or two; although a fully grown healthy adult may be able to fast for some weeks before breaking into protein stores, the developing child needs feeding to survive and build a robust psyche to meet other psyches; mental health is based upon social health as is sexual health.
As the length in time in practice continues, I come to the half–thought conclusion that those who are easily fragilised, who may have been a little frail in childhood or those who cycle between a set of symptoms (in other words, those whose attainment of poise is difficult), are perhaps a little more likely to make old bones than those who from a young age have seemed to enjoy robust good health. If true, it is a weak bias, but one that can be fortified against by the consumption of plants as foods or medicines. Plants will, in any case, do wonders for those who suffer from chronic malaise.
I hope that the reflections and reiterations in this second part of the book will provide practical help for herbal practitioners by some focus on the theoretical assumptions we make about those who seek our help.
I have mostly employed the customary practitioner/patient relationship as a way of portraying the mediation of health, because the book is addressed primarily to therapists and it would be cumbersome to substitute for the so–called patient the more authentic notion that health comes from happiness and is also maintained in a person by exercise, diet and the maintenance of good relations with other people. All these build resilience. Although there is a very small step between helping people and knowing what is best for them, I have decided to stick with the patient as focus because all of us suffer at some point in our lives and need an ally in an hour of need.
But medicine dominates our culture in both soft and hard ways. Soft power is the friendly approach to advice that wouldn't want to step on anyone's toes while offering dietary and other advice that is said to be about “lifestyle” as if most of us are so deliberately stylistic; I hope to combat these bland assumptions. At the opposite pole, the imperialism of medical practice can express hostility and rage to anyone who questions the orthodox approach. The demon evidence is invoked to maintain ideological conformity; it is a shortcut which the Holy Inquisition might have envied. A demon by which, by a supreme irony, Galileo was forced to recant what he had experienced and fully understood. Then nonsense was orthodox and natural observation heretical. In the so–called developed world, nutrition and medicinal products are both in the hands of indoctrinate market forces. These embody the tyranny of choice and suppress the happiness of adequate plenty. Government is liberal to the patient as consumer (and as voter, which further entrenches the corruption) so that we are all free to be less poor than those who most need help, but is illiberal to any thinking about the kind of medicine that might be suitable for the individual, or to favour health education over palliative pharmacy. The failure of the campaign to regulate herbalists in Britain founders, in the end, on the doctrinal paradox that we are seen to do no harm. To regulate what might appear from a narrow pharmaceutical perspective to be a placebo practice would throw even more light on the admitted harms from pharmaceutical drugs. In fairness, ministers are accountable for public funds but their hands are also tied by doctrinal strings and are as likely to be criticised for indulgence as they are for intervention. The nanny of the so–called “nanny state” is not illiberal enough when it comes to preventing social harm: she could figure well as a model for the central figure in Hogarth's “Gin Lane”.95
In this second part, I have looked at the person as we see him or her in the clinic and how a person might be in their own environment. I have tried to sidestep a doctrinaire approach to herbal medicine while accepting that we all make distinctions between the plausible and the barely credible.
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95 London 1751; his satire was also aimed at the heedless affluence created by a callous free-market economy. At the time of writing, a modest proposal situating and advertising sweets to children is planned to be in place 12 years hence! A lot of harm can be done to a lot of people in 12 years.
SECTION EIGHT
Public health and medicine
It seems almost inevitable that people will take good enough medicine for their ailments: medicine–taking seems to be a human trait, even when much of it is ineffectual. While there's life there's hope.
I was born in the opening years of the Age of Antibiotics which has changed, for a time, the effectiveness of medication, at least for infectious illness. Even so, all extensions of any population's lifespan through reductions in infant mortality and adult morbidity are achieved by Public Health measures, not by medication.96 Does this make all medication little more than palliative? If that were so, there would be little point to books on health that feature medication unless the sanitary measures we take for granted and the clean water we can drink from our taps are also in place.97 As this claims to be a book on health, I had better answer the charge right away that many of its suggestions cannot be compared with the clean air and water we are used to and so will be irrelevant to health outcomes at the population level.
First, I would say that my idea of Poise aspires to a life with less illness rather than an extension of life, and second, that the Health Measures rightly sought by policy makers and the statistics generated do not fully take into account personal, social and cultural subjectivities. It is assumed that developed nations like ours with increasing lifespans are uniform in our responses to health and medicine.98 The book you are reading makes no such assumptions, and also resists a simple tale of two approaches: conventional and alternative, where for “and” one might read “versus”. Anthropologists examine the social variation in belief in populations in what is known today (but for how much longer?) as the developing world and take account of the richness and subtlety they find there, the better to advise policy makers. In our so–called developed world, the metrics tell us that we have no need for variation of belief, let alone subtlety, because health is a commodity and that it is assured by “health providers”. Field workers in the Developing World are trained against the risks of patronising their clients, but doctors and nurses in our Health Industry take no such precautions despite a cloying piousness towards the rights and needs of the patient which amount almost to veneration. This approach seems to me an inevitable consequence of the sycophancy that advertisers deploy to beguile their customers. It may also be a reaction against the peremptory, even harsh, approach displayed by pre–NHS medics. In spite of the prevalence of sycophancy towards the sick, it is a veneer that barely sticks to the surface: if you want to experience rudeness and arbitrariness that would not be tolerated in any other non–criminal sphere, visit a doctor's surgery.
At the population level, public health measures and social policy towards women and babies and the early lives of the disadvantaged are of inestimable importance compared to the medicating doctor (or herbalist)