Medicine
Sans everything
John Linklater
The general practitioner is often brought face to face with examples of the way in which the social , services are brainwashing the public. In no sphere is this ploy more apparent than in geriatrics, nor at any season more than Easter. Easter is a time of promise and of hope. Some are so old as to be impervious to the soul-stirring effects of a bright morning or to the increasing numbers and species of the choristers in the damn chorus. Which of us, during his round of visits on a sunny spring day, has not come across grandfather contentedly touching up the paint on his old gate post, or grandma scouring out her cooking pots with renewed vigour?
But the social services are bidding fair to destroy the fun of survival for the elderly by so reorganising their lives that they allow themselves to be isolated from all that is familiar and truly meaningful, in return for new forms of labour-saving comfort which tend to strip their lives of any residual illusion of purpose.
So long as there are logs to be cut, or scuttles of coal to be brought in, and a fire to be poked and stoked, so long as there is a rambly patch of garden to be cleared and so long as there is an impossible dark lumber cupboard to be springcleaned, the surviving game is indisputably there to be played, for all to see. Providing that the inconveniences and obstacles remain reasonably surmountable, then there are always comprehen • sible familiar and reassuring things to be grumbled about: the zest for lite tends to remain. The trouble is that Social Services committees, in their devastatingly well-meaning overpoweringly kindly adolescence, take the grumblers literally. They simply remove old folk from the world which they comprehend.
The sad thing is that old folk usually look forward to the move with unsuspecting pleasure. They confuse, as we all can, the joy of anticipated betterment with the reality afterwards. The general practitioner often sees this more clearly than do his patients, as he recalls the letters which he has been prevailed upon to write, asking for priority to rehouse some octogenarian lady on account of her arthritis coupled with her awkward staircase, to take but one common example. Yet it is when she is installed in the haven of her dreams that her real troubles begin. She knew those stairs, like the palm of her hand and could in fact negotiate them in perfect safety, but she slips on the new mat and fractures her femur.
The truth is that very old folk generally suffer from some degree of chronic damage due to repeated trivial cerebro-vascular accidents It is this which accounts for their reliance upon habit patterns and for their lack of adaptability. They do not, therefore, tolerate much change: and it is well known that they will become disorientated and lose heart if they are moved about when ill.
Old people come to depend greatly upon their personal goods and chattels. Great Aunt Smithy's wardrobe may well be a cumbersome eyesore, but it is one of Great Aunt Emily's external anchors, lending her a stability that the new fitted wall cupboard can never replace. No more can uniformly, thermostatically controlled temperature replace Great Aunt foriner daily contact with the challenge of the change of season, the crisp onset of winter, the ruffling bluster of a draughty floorboard, or its archetypal promises of spring.
There is no controlled evidence to show that old folk live longer in purpose-built, centrally heated rabbit hutch type accommodation. Indeed, experience suggests the opposite. Neither do they appear to be more healthy when re-housed where, if one may judge by their incessant demand for tranquillisers, anti-depressants and hypnotics, rehousing more often leads to a real loss of contentment. Nevertheless, government spending on the project is carried out with a :zeal which far exceeds even the usual slap-happy Cheerfulness of the man who is giving away resources which have been earned by others. It is as if there were some as yet unrivalled ideological purpose served simply by moving people about, regardless of the real value of so doing.
It should also be recalled that the act of rehousing symbolically accepts that the care of old folk has become a government responsibility. This causes a reduction in the natural urge to filial piety and devotion. Old folk are thus not only cut off from the latter, but also, to some extent, from all challenge and contact, often even their own' families.
These general observations do not imply that there are no examples of old people upon whom rehousing has conferred great overall benefit. They do, however, demonstrate the need to approach geriatric care with less than the ebullient enthusiasm of the average social services planner. It might, indeed, be far better to spend the available resources on' more modest, but more imaginative, ways of making the lives of old people richer and more stimulating in the homes in which they live and thus helping them to go on having the fun of being independent. But such non-headline ways of preserving a sense of individuality and meaning would not commend themselves to the executive of the Welfare State. The general practitioner will therefore, no doubt have to go on propping up and anti-depressing, while the social services go on pretending that all old people become healthier and happier as soon as they are stacked away, out of sight, side by side, aimlessly, in tidy rows.
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