The road movie

The defense of public healthcare is shaping up to be a lost battle between Spanish citizens and the Rajoy government's favoring of private interests. This can be defended in strict terms of business logic, but not when privatization proceeds from a neoliberal bias, all the more so in a country such as ours where there isn't even a guarantee of respect for the capitalist principle of rewarding the best manager. Given the way Spain works, we can predict a further spread of clientelism, consisting of assigning the juiciest hospitals to the best friends of the governing power. The same goes for university "reform."

The effects are already observable in regions where this crooked logic is now being put in practice. For patients or their representatives, opacity is the invariable rule when a service is refused or dangerously postponed. It is rare indeed to hear a doctor admit that, two years ago, you had to wait only weeks instead of months for a test. This is understandable: the way things are going, why jeopardize your job by playing Don Quixote?

When it comes to illnesses that are still viewed pejoratively -- such as mental ones, however much the language relies on euphemisms such as "handicapped" and "challenged" -- the gap between needs and resources is spectacular. A year's wait, I am told, for middle-or-long-term hospitalization. There are magnificent small residences, for rehabilitation, but these are showcase operations that can be counted on the fingers of one hand. Meanwhile, in quality hospitals it requires a wait of months for indispensable tests to be carried out.

You can come up against a psychiatrist who does not recognize a textbook case of schizophrenia but insists that his remuneration should be in cash

The opacity has another dimension that is less well-known: the protection of incompetence. In the long odyssey of schizophrenic treatment (comparable, not quite accurately, to that of a mental patient) you may encounter all sorts of, well, improper conduct, to attach some term to it.

A friend told me that in the "road movie" he lived to obtain treatment for a relative, the only thing missing was a Grand Inquisitor. Right at the start, you can come up against a psychiatrist who, in the course of two years, does not recognize a textbook case of schizophrenia; who speaks, first, of "immaturity," and then of "something funny;" but who is precise enough in one thing: that his remuneration should be in cash, and not through the channels of the insurance company. Then, due to a crisis, a short stay in a place where the patient suffers violent handling that leaves marks on him. Later, a more imaginative psychiatrist opined in his report that the patient suffered "demonic possession" (no, I'm not making this up).

Yet it would be unfair to reduce the whole to a museum of horrors. At times, and in stays in certain centers, the patient received effective attention that propitiated phases of recovery, until his treatment in one of these centers came into conflict with an abrupt decision that he ought to leave. Couched in a jungle of euphemisms, the diagnosis suddenly ceased to be "paranoid schizophrenia" and recommended "community rehabilitation." That is, out in the street with you, and a sharp drop in medication. This led to a grave psychotic crisis, from which the patient never recovered.

The coverage from higher up was always exemplary -- from a guild-interest point of view. Only through cracks do the reports allow a glimpse of reality. Our story ends with complications not directly originating in the disease itself, though they may have had to do with combinations of drugs, the risks of which are even warned about on the instruction leaflet. The recorded video of the crisis was not viewed by the doctors until the patient was already out in the street, with no clear diagnosis. The top doctor never saw it. However, the patient's sudden death was followed by a telephone message of regret, from a subordinate.