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Symptoms and meaning

January 18, 2008

From the News: A police Inspector? was bailed for one violent offence. He murders the key witness to the offence. The Judge states he does not know why he gave him bail. Let’s speculate….

There are certainties about the Police. They know to murder is illegal. They understand about interfering with witnesses to criminal cases. The Judge makes a decision based on these predictions. It was wrong.

The Health Professions Order 2001 was put on the statue book to ‘safeguard the health and wellbeing’ of the population. The chief threat was Dr Shipman, a murderer, who was undetected because he was a very good doctor. HPO2001 is alleged to prevent the recurrence of uncertainty by regulation. It regulates every aspect: training, clinical decisions, fitness to practice, continuous professional development so that certainty is produced.

Evidence-based practice is one of the procedures for limiting the government’s financial liability. (Risk Analysis, appraisal, are some of the others) It takes the problem (let’s say anxiety) and measures how effective various practices are in erasing the symptom. The erasure is quite short-term – let’s say not recurring within 6 months. No account is taken of differences between those who apply the procedure. They are assumed not to affect the treatment’s efficacy. A uniformity is assumed about the initiating problem or symptom. The symptom is separated from the person and the meaning of their life and given a meaning. The result is always uniform. The uniformity of the process going from symptom through process to result measurement is possible. Which practice gives the result in the most cost-effective manner? Let’s compare the givers of the processes to see who is most effective. These ‘scientific measurements are operating within certainty. There is no room for difference in the problem, the procedure or its giver or the result. Any difference is blamed on maverick factors outside the certainty system.

Psychoanalysis allows difference in problem, the process used and the result mainly because it relies on relationship. Relationships do not register with evidence based practice. This is why psychoanalysis is associated with uncertainty.

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