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The Sick Child's Predicament*

There is widespread criticism of medicine which contrasts with its manifest success in biotechnology. Medicine's failure to convince stems partly from the fact that its successful biotechnology distracts it from the mundane task of responding appropriately to components of commonplace sicknesses which do not stem from disease (things) or illness (symptoms) but from predicaments. Predicaments are painful social situations or circumstances, complex, unstable, morally charged and varying in their import in time and place, which are readily discernible from a good history. Predicaments are distinguished from environmental agents by being an aspect of social organisation rather than structures. Dangerous and excruciating predicaments are described as well as the predicaments of being sick, and being in hospital. Child psychiatrists are often presented with problems where diagnosis of disease or illness in the child is inappropriate and resolution of its predicament alleviates the distress that had been presented in the language of sickness. The model is capable of broader application in psychiatry and medicine. Doctors should be more concerned to know about the context and background of their patients' sickness, as patients give this information very freely if asked. If patients' complaints are misunderstood then medical responses, made in good faith, may be seen as dangerous intrusions leading to a loss of trust, anger, and litigiousness.