Antonio Lanfranchi - Modern Myths and Medical Consumerism: The Asclepius Complex

Once the acute phase of a serious illness has passed, the violent reactions of the psyche to the narrow escape from death generates intense conditionings and constellates often unconscious meanings, in the form of images or fantasies, which are channelled by the collective consciousness, so that this becomes an effective container for them. During this phase, rationalization is a fairly common defence mechanism; sometimes denial or splitting occurs. In this process the doctor may make a prudent contribution, sensitive to the processing of defensive reactions by the patient. It is more common for the doctor to choose a neutral position, fomenting the technological automatism of treatment, by encouraging patients to use their own faculties of processing with little or no help, and strengthening their defences, when these facilitate the execution of the treatment programme. The over-medicalization of society is in my opinion increased by the prevalence of this approach. A concretistic obsession with pills, or sometimes a one-sided rejection of them, an insistence on continuing treatment or rejecting it passively, added to the oppressive sense of the burden one is laying on society, are all driven by a failure to process the experience of illness and the treatment that is applied.

It is not surprising, however, that the considerable improvement in health and quality of life provided by technological medical progress is not perceived as such by many patients. Although modern medicine is incomparably more effective than in any other period, the doctor is not accorded the same unconditional trust that used to be placed in the family doctor. My profession, as a hospital cardiologist in one of the public hospitals of Milan, gives me daily experience of the remarkable effectiveness of technological medical operations for the survival of heart attack patients. Rapid recovery tends to lead to denial or repression of the experience of illness. Therapeutic success in acute cases has also caused a gradual increase in the evolution towards chronic illness, owing to the fact that an increasing number of patients survives until the advanced stages of heart disease. These patients suffering from chronic heart failure are faced with frequent hospitalizations and limitations on their bodily functions (and quality of life), the growing socio-economic cost of which places an increasing burden on the health service, and leads to greater social exclusion, as well as loneliness, anxiety and depression (at least a fifth of heart patients are affected by a major anxious or depressive disorder). In such patients, who are more in contact with their own vulnerability and dependence, I often sense a deeper, sometimes unex-pressed thirst, which expresses itself, despite all their attempts to deny it, in a gentle humour, free from absolute expectations. It is an approach which perhaps once found an echo and sublimation in the great container of tradition, through religion, myths and folk tales.