SICKNESS AND THE SOCIAL COMPACT.

Abstract

Epidemiological research in social psychiatry has shown a relationship between the social class of patients and the psychiatric illnesses from which they suffer. It also appears to be true that patients of a particular social class are treated by psychiatrists of a particular social and professional ideology, either physico-medical or analytic-psychological. Thus every doctor-patient relationship may be regarded as a social compact, the implicit terms of which are accepted by each participant as binding upon himself. The terms of expectation and obligation of the traditional medical ideology so encumbers this social compact, when it is joined for psychiatric purposes, that it must inevitably fail by making it either easier to be ill or impossible to be well. The only possible way of proceeding is to open the compact itself for investigation and its terms for negotiation. This procedure, at the same time, brings one to grips with the terms of the illness itself.