I increasingly think that Mark Fisher’s perspective on the politics of mental health can be expanded to the politics of health more generally. It is not simply that social causes of illness are individualised, but that one can be anything but an individual in medical contexts.
The NHS is great at treatment, and in some respects great at rapid diagnosis and response (cf. NHS 111), but the diagnostic system more generally is *completely* fucked, and fucked in ways that disproportionally affect both marginal groups and weird individuals.
Here's one thing I have seen: a friend who was symptomatic for over a year was only diagnosed with cancer when his lymphoma reached stage 4, at which point he had a tumour between his vertebrae and his neck was distended; and only then because my brother suggested it to the GP.
Here's another: I saw it take 7 years of constant struggle against an indifferent system for someone to get her chronic pain taken seriously enough that they finally found the gallstones and removed her gallbladder. 7 years of debilitating pain and diagnostic gaslighting.
There are more stories, and I'm sure everyone has a couple of these, either of their own experiences or those of their friends and family. It is entirely possible to be trapped in a diagnostic loop by the often more or less random string of GPs we will see in seeking help.
Worse still, there are halting states: terminal points in the diagnostic tree where you are slotted into an ersatz category whose meaning is: 'something's wrong with X, now you figure it out'. (e.g., Irritable Sowel Syndrome: 'What? My bowel is irritable? You don't say!')
And the worst? Being put in a category that means 'you figure it out' and then being told 'no, not like that,' when you try to. All the downsides of paternalism with none of the fringe benefits.
This is a system that fails despite the fact that the GPs who act as our interface to the diagnostic tree are highly trained and highly experienced. Indeed, it often fails because they have *so much* experience they are oversensitive to signs of misdescription and hypochrondria.
The politicians and managers who have mangled the system over the last few decades have successfully optimised for just those conditions in which GPs make overconfident snap judgments about potential false-positives in self-reported symptoms.
They've turned the interface to the entire health system for anything less serious than an obvious and extreme condition that would make you dial 999 (or 111) into an adversarial interaction in which one side tries to signal harder, and the other finds better ways to ignore it.
Often, what this looks like is: waiting 2 weeks for a 10 minute appointment with a GP who is somewhere between helpful and harmful, and who one has no guarantee of ever seeing again, or successfully passing on any information to the next one you see 2-3 weeks later.
I'm not trying to be too harsh on GPs here, because I have had some great interactions with them. However, these are correctly described as great interactions *despite* the constraints imposed on them, not *because* of them.
But I have also had the process of finding adequate medication for a debilitating chronic pain condition held back 6 months by a single GP's capricious decision that literally ever other health professional I have spoken to thinks was *inexplicably* wrong.
And I know I've got off lightly, because I've seen what happens to women with chronic conditions of every kind, and how they are systematically made to feel as if they are making up their symptoms. The pattern is *painfully* obvious.
If nothing else, the psychic damage of living with symptoms that no one will just give you a word to describe, a short phrase to communicate and validate your suffering in the eyes of everyone and every institution around you, is often as bad as the condition itself.
If this system fails even when the people on the diagnostic front line are highly trained and highly experienced, why in the ever-loving-fuck would we think it would work when they're petty-minded bureaucrats incentivised to decrease benefits claims?
The DWP is a conceptual monstrosity, even before it is an empirical tragedy.
I think this is precisely what Mark meant by 'market stalinism': senseless bureaucracies consuming the resources that should be spent to free their charges from suffering to break their spirits and beat them into shape instead. In United Kingdom, gulag builds you.
