Un-demonising the marginalised

[摘要] In The Time Machine by HG Wells, a ‘gentleman scientist’ travels into the far future and finds that humanity has evolved into two distinct species; The Eloi are innocent, docile, and largely idle, and are preyed upon by the Morlocks, feral monsters who live underground. As Wells describes it, ‘Ages ago, thousands of generations ago, man had thrust his brother man out of the ease and the sunshine. And now that brother was coming back changed! Already the Eloi had begun to learn one old lesson anew. They were becoming reacquainted with Fear.’ 1This month’s theme is ‘marginalised people’. The very word ‘marginalised’ conjures a sense of us and them, and a space that we inhabit. At the boundary of our space and the outside lies the ‘margin’. Some people end up at this border and others are excluded. Those inside who enjoy the (relative) ease and sunshine risk unjustly marginalising even excluding others. O’Carroll’s essay points out that many of those who we label as having personality disorders may be so because of poverty and adverse childhood experience. By labelling people as vicious or faulty rather than damaged we render them ineligible for help and sympathy while exculpating our society from mitigating and preventing lasting psychological harm.2We fear the marginalised patient because they might invade our ease and sunshine. Many a clinic has run late because such a person’s needs or ability to engage with services do not fit into half an hour, much less 10 minutes, and such frustration in a system under pressure can lead to less charitable thoughts and feelings. Populist politicians can make Morlocks of those who can easily be ‘othered’. Monahan, in reflecting on an elective in homeless medicine, takes this idea further, and challenges us to consider that our place in the ease and sunshine is in large part an accident of birth: where we were born, who raised us, and the opportunities we have been given.3Churchill reminds us that an entire generation of young people were disaffected and disadvantaged in terms of their health and access to health care even before the pandemic made things worse.4 Access and continuity loom large in the 10 most read articles in last year’s BJGP.5 The link between continuity of care, health outcomes, and survival was astutely picked up by the chair of the UK Health Select Committee, The Rt Hon Jeremy Hunt MP. I hope he recognised that making the barriers to access the responsibility of a named GP does not of itself solve a problem that includes chronic underinvestment, workforce depletion, and social factors that make continuity difficult to sustain. Being ‘named’, at worst, is only a way to be ‘blamed’.

[学科分类] 卫生学