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The hidden health care system: Mediating structures and medicine
‘54
Book Re\,e\\s
The Hidden Health Care System: Mediating Structures and Medicine, by LOWELL S. LEVIS and ELLEN L. IDLER. Ballinger. Cambridge. MA. 1981. 272 pp. S19.00. At the same time that I was invited to revie\\ Louell Levin’s and Ellen Idler’s very interesting book. .\frc/itrrinq Srr~rcrcms. I was introduced to the work of Richard Cabot. Cabot practiced medicine at the Massachusetts General Hospital from 1894 to 1919. He observed the change in medicine that occurred when the emphasis of practice changed to focus on the objective quantifiable studies of disease. Cabot. whose recognition of the social needs of patients led to the development of medical social work. wrote in 1911:
.
I want to throw open the windows and get out of this narrow medical atmosphere in which the enormous healthful influences of the outside world are so largel! disregarded. (Richard C. Cabot, Personal Letter to James Jackson Putnam. February 17. 1911. C4 2. Harvard Medical School Archives).
As a response to the expansion of scientific medicine into every sphere of human experience. this book will serve to raise the consciousness of the health professional about the real world in which people live and all the forces that influence how they feel and behave. The authors decry the medicalizing (a word coined by Irving Zolal of many aspects of human life such as birth and death. They identify the family, religion and community resources as contributors to people’s good health and sense of well being and effective counterforces to the formal health svstem. They see these counterforces as health providers-in their own right. Using examples from the home birth movement and the charismatic healing movement, Levin and Idler document what people can and do do for themselves. In many ways this book is an appreciation of these helping efforts that have existed from time immemorial. However, they have given them a new name, “mediating structures” and see them as taking on new functions. In.essence. they see individual affiliations in a variety of social groups servmg to mediate between the depersonalized megastructures of modern society and the private. more personal sphere in which each of us lives out our daily lives. In fact no life is viable without its being anchored in the mutual helping networks and exchanges in which we all participate. Levin and Idler. however, emphasize one function. that of treatmg oneself and members of one’s family for a wide variety of physical illness and discomforts. They see self care as an alternative to what thev describe as the impersonal. often iatrogenic. health care system. Their use of the mediation concept implies that the two systems are opponents m some kind of battle for which a middle man is needed. They write as If people either totally \urrender their care to the professionals or withdraw from them totally. I think that. like their health cart colleagues of whom they are $0 critical. Levin and Idler endow the health care system with too much power. Many professionals have tried to educate consumers to defer to the medical expert and to rcscrve for the medical expert matters normally rcservcd for the family or the clergy. As yet there i\; no evidence that this educatlonal effort succeeded. In fact. most pcoplc. for better or worse.
orchestrate thrlr onn care and rescr\e for themsel\c decision about \\hom to consult and \\ hen. E\el authors cite sources that support these ob\er\ations. The book is di\lded into 5 chapters in \\hlch Ls\it Idler describe the health care s!stem \\lth its limlta and mediating structures. The\ Identlf! the famll! care. religious groups and heahng and communlt! 5 and mutual aid as examples of such \tructures. Thr chapter discusses the meanmg of mediating structurt public policy. Each chapter 1s a jewel. pro\idlng the r# with an overview of current research and a clear plct( how each system provides serbIce to its constituents. I mg on their “healthful inlluences”. I do not think. however. that thi- concept oi mediat appropriate. None of these systems duplicates the se, of the other. I cannot practice medicine. If I .Lm serl 111.I cannot practice good “sickness care” \\ hich ma! to include my family and my church as \\ell as rn> efforts on my behalf. We are talkmg of cooperatlor collaboration. not mediation. I share Levln‘s and l goal of wanting to humnnlze the health care system. will be done when the system stops talking about “m, ing” cases. stops acting “on” people. and beeins to r . nize the need to act “with” people as partners, In-the last chapter on Mediating Structures and F Policy. the authors propose that in plannmg health needs, planners need to consider mediating structur legitimate. effective and economical health care pro\ They use their “discovery” of these structures to J limiting public support to health care and human s( systems. If this book were not sponsored by the Ame Enterprise Institute. these recommendations coul argued at face value. However. the AEI is a center \ conservative policy recommendations are bemg i mented by the administration in Washington. which s intent on cutting support of human services or lookil a rationalization for it. As a consequence. m a peri high unemployment. there 1s an accompanying cut in unemployment benefits. Medicaid coverage IS I severely cut back. Lunch programs for school childre no longer subsidized. doubling their cost. Educat funding for the handicapped IS being threatened and plemental social security payments are frozen. thus m: it impossible for the elderly and the disabled to mai even a minimum standard of living. Even mediating s tures need resources. as do agencies and institutior order to work effectively. These are contmually bein back in the name of minimizing the intrusion of 90 ment agencies into the private life of the Individual. effect of these current efforts is to immobilize these mf tng structures, therefore we must exercise caution in observations. such as Levin and Idler make in this I are used. My hestitatlons notwithstanding. I think that authors’have written an interesting book highlighting enormous healthful influences of the outside worlc often ignored by the health care practitioner.
PHYLLIS R. SILVEF
Book Re\,e\\s
The Hidden Health Care System: Mediating Structures and Medicine, by LOWELL S. LEVIS and ELLEN L. IDLER. Ballinger. Cambridge. MA. 1981. 272 pp. S19.00. At the same time that I was invited to revie\\ Louell Levin’s and Ellen Idler’s very interesting book. .\frc/itrrinq Srr~rcrcms. I was introduced to the work of Richard Cabot. Cabot practiced medicine at the Massachusetts General Hospital from 1894 to 1919. He observed the change in medicine that occurred when the emphasis of practice changed to focus on the objective quantifiable studies of disease. Cabot. whose recognition of the social needs of patients led to the development of medical social work. wrote in 1911:
.
I want to throw open the windows and get out of this narrow medical atmosphere in which the enormous healthful influences of the outside world are so largel! disregarded. (Richard C. Cabot, Personal Letter to James Jackson Putnam. February 17. 1911. C4 2. Harvard Medical School Archives).
As a response to the expansion of scientific medicine into every sphere of human experience. this book will serve to raise the consciousness of the health professional about the real world in which people live and all the forces that influence how they feel and behave. The authors decry the medicalizing (a word coined by Irving Zolal of many aspects of human life such as birth and death. They identify the family, religion and community resources as contributors to people’s good health and sense of well being and effective counterforces to the formal health svstem. They see these counterforces as health providers-in their own right. Using examples from the home birth movement and the charismatic healing movement, Levin and Idler document what people can and do do for themselves. In many ways this book is an appreciation of these helping efforts that have existed from time immemorial. However, they have given them a new name, “mediating structures” and see them as taking on new functions. In.essence. they see individual affiliations in a variety of social groups servmg to mediate between the depersonalized megastructures of modern society and the private. more personal sphere in which each of us lives out our daily lives. In fact no life is viable without its being anchored in the mutual helping networks and exchanges in which we all participate. Levin and Idler. however, emphasize one function. that of treatmg oneself and members of one’s family for a wide variety of physical illness and discomforts. They see self care as an alternative to what thev describe as the impersonal. often iatrogenic. health care system. Their use of the mediation concept implies that the two systems are opponents m some kind of battle for which a middle man is needed. They write as If people either totally \urrender their care to the professionals or withdraw from them totally. I think that. like their health cart colleagues of whom they are $0 critical. Levin and Idler endow the health care system with too much power. Many professionals have tried to educate consumers to defer to the medical expert and to rcscrve for the medical expert matters normally rcservcd for the family or the clergy. As yet there i\; no evidence that this educatlonal effort succeeded. In fact. most pcoplc. for better or worse.
orchestrate thrlr onn care and rescr\e for themsel\c decision about \\hom to consult and \\ hen. E\el authors cite sources that support these ob\er\ations. The book is di\lded into 5 chapters in \\hlch Ls\it Idler describe the health care s!stem \\lth its limlta and mediating structures. The\ Identlf! the famll! care. religious groups and heahng and communlt! 5 and mutual aid as examples of such \tructures. Thr chapter discusses the meanmg of mediating structurt public policy. Each chapter 1s a jewel. pro\idlng the r# with an overview of current research and a clear plct( how each system provides serbIce to its constituents. I mg on their “healthful inlluences”. I do not think. however. that thi- concept oi mediat appropriate. None of these systems duplicates the se, of the other. I cannot practice medicine. If I .Lm serl 111.I cannot practice good “sickness care” \\ hich ma! to include my family and my church as \\ell as rn> efforts on my behalf. We are talkmg of cooperatlor collaboration. not mediation. I share Levln‘s and l goal of wanting to humnnlze the health care system. will be done when the system stops talking about “m, ing” cases. stops acting “on” people. and beeins to r . nize the need to act “with” people as partners, In-the last chapter on Mediating Structures and F Policy. the authors propose that in plannmg health needs, planners need to consider mediating structur legitimate. effective and economical health care pro\ They use their “discovery” of these structures to J limiting public support to health care and human s( systems. If this book were not sponsored by the Ame Enterprise Institute. these recommendations coul argued at face value. However. the AEI is a center \ conservative policy recommendations are bemg i mented by the administration in Washington. which s intent on cutting support of human services or lookil a rationalization for it. As a consequence. m a peri high unemployment. there 1s an accompanying cut in unemployment benefits. Medicaid coverage IS I severely cut back. Lunch programs for school childre no longer subsidized. doubling their cost. Educat funding for the handicapped IS being threatened and plemental social security payments are frozen. thus m: it impossible for the elderly and the disabled to mai even a minimum standard of living. Even mediating s tures need resources. as do agencies and institutior order to work effectively. These are contmually bein back in the name of minimizing the intrusion of 90 ment agencies into the private life of the Individual. effect of these current efforts is to immobilize these mf tng structures, therefore we must exercise caution in observations. such as Levin and Idler make in this I are used. My hestitatlons notwithstanding. I think that authors’have written an interesting book highlighting enormous healthful influences of the outside worlc often ignored by the health care practitioner.
PHYLLIS R. SILVEF