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Out of the presented in
Table 3 evident motives that are most often quoted in scientific literature the last two
are worth especial noting. The motive to overcome a discrepancy between measurements in
different cultures has been accepted as a basis by the WHO methodology (which is natural
for an international organization of such a high status). This motive manifests itself,
for instance, in the fact that practically at all stages of developing the instrument the
entire work is being done by regional centres in their native languages using as experts
the bearers of each specific culture (i.e. patients and doctors) and making subsequently a
close translation and co-ordination of outcomes. The motive to increase the reliability of
administrative information in health care is becoming more and more topical as we come to
understand that high-level administrative decisions can be fraught with very grave
irreversible consequences, as it has probably happened in case with the deinstitualization
of mental patients in a great number of developed countries. For instance, the analysis of
the process of making a decision to introduce deinstitualization (Ruth Taylor and Graham
Thornicroft, 1996) that has thrown out in the street a great number of incapable persons
who, which is more important, cannot use social protection and social psychiatry services,
gives every reason to consider that not all requirements of making correct samples in
scientific investigations were met. Errors of this type can also occur as a consequence of
a large-scale use of not quite valid instruments for measuring treatment effectiveness,
for instance, if they do not differentiate the life satisfaction of a well person from
that of a mental patient with a chronic course of disease and a certain type of defect.
The mentioned types of patients often demonstrate high life satisfaction even being put
under living conditions which can hardly be considered as tolerable from the humanitarian
point of view. As persons with serious mental disablement, they can feel themselves quite
“happy”. This state of “happy disablement” can be considered a benefit in cases
when the patient’s adaptive resources are exhausted; but what if they are not exhausted?
The true value of such questionable satisfaction becomes evident when we find a high level
of morbidity and mortality (including suicidal one) in this category of patients. A
large-scale use of not quite valid instruments can beget a public health care system,
which, in its turn, will beget this very type of “happy disabled persons”. The
instrument assessing treatment effectiveness according to a subjective satisfaction or
well-being criterion becomes an element of macrosocial feedback that influences the choice
of treatment methods, i.e. influences their market, and, consequently, begins to influence
the production of these methods. The production of drugs that increase one’s life
satisfaction due to a decrease in the intensity of one’s life experience can, in its
turn, force out from the health care market more effective, from the medical point of
view, treatment methods, thus actually causing the emergence of latent mass social
“pharmacolobotomy”. Instead of the known untoward effects of drugs, there can appear
or, which would be more correct to say, can be legalised by means of measuring instruments
other side effects which would be even more difficult to treat. |
