Essay
overlap. In addition the human face of
professionalism appears to be relatively
undervalued, and there is no link with a
role within the local community. We will
now try to see if the construct of the
mensch helps us here.
The definition of mensch is variable,
partly because it comes from a verbal
tradition rather than a written one. A
definition from the US is: ‘A person having
admirable characteristics, such as
fortitude and firmness of purpose, who
radiates a kind of fundamental decency’.13
A further even shorter definition is: ‘A
decent responsible person with admirable
characteristics’.14 These attributes may be
difficult to define, but culturally
communities would pragmatically
recognise a mensch, even if they might not
agree on all the appropriate characteristics
comprising such a person.
It is noteworthy that there is no
completely and universally agreed
definition of a mensch, just as there is no
agreed definition of professionalism. We
propose that attempting to define terms
too rigorously risks missing the point of
acknowledging and recognising the
overlap of ethical and humanistic
qualities that are central to the constructs
of both. Further, as practical, pragmatic
professionals working with our patients,
every GP would surely be able to
recognise the principles involved in both
the mensch and professional values.
There is now a challenge to every general
practice-based medical educator to
demonstrate the depth of professionalism
in ‘everyday encounters’ to medical
students.
HOW DO STUDENTS LEARN TO
BE PROFESSIONALS?
Undergraduate medical students are
expected to learn about professionalism,
although how they do this is unclear; it
has been noted before that previous
generations were not overtly taught but
rather learnt by ‘osmosis’.15 At this
Mike Fitzpatrick
Nature therapy
Natural England has launched a health
campaign which aims to ‘encourage’
GPs and other health professionals ‘to
make more use of the natural
environment as part of the total health
care they give to their patients’.1
According to William Bird, a Berkshire GP
and Natural England’s health advisor,
‘increasing evidence suggests that both
physical and mental health are improved
through contact with nature’. A campaign
fact sheet claims that ‘aggression and
domestic violence is (sic) less likely in
low-income families with views or access
to natural green space’ and that ‘crime
rates are lower in tower blocks with more
natural green space than identical tower
blocks with no surrounding vegetation’
(no references provided).
Dr Bird is worried that ‘people are
having less contact with nature than at
any other time in the past’ and insists that
‘this has to change!’.
Natural England’s campaign, which is
endorsed by the Deputy Chief Medical
Officer and the BBC and supported by a
budget of £500m of taxpayers’ money,
offers a curious combination of the silly
and the sinister. On the one hand, the
notion that a breath of fresh air and the
sight of a few trees can cure the ills of
both the individual and society has the
aura of whacky Green fundamentalism.
On the other hand, Dr Bird’s
schoolmasterish tone and his offer of a
natural cure for a wide range of social
problems clearly appeals to the
authoritarian instincts behind New
Labour’s public health policies.
While Natural England presents itself
as the acme of fashionable
environmentalism, its roots lie in the
tradition of ‘nature therapy’ that
flourished in Germany from the turn of the
20th century and reached its peak in the
Nazi Third Reich. Nature therapy
combined hostility towards scientific
medicine with enthusiasm for
homeopathy and hydrotherapy and was
closely aligned with eugenics and racial
superiority. ‘Air, light, a healthy diet and
exercise were recognised as the basis of
good health’.2 Although in its early days
this movement drew support from across
the political spectrum, in the 1930s it was
incorporated by the Nazis and the Reich
Labour Service (Reicharbeitsdienst)
became a means of mass conscription of
the unemployed into conservationist —
and health enhancing — rural labour.3
Franklin D Roosevelt’s New Deal
government in the US followed the
German example with the Civilian
Conservation Corps.
By the time that Brigadier Armstrong
formed the British Trust for Conservation
Volunteers (BTCV) in 1959, the
movement had abandoned its coercive
and eugenic features and had become a
benign voluntary organisation devoted to
practical conservation work (though in
1970 it acquired a deeply reactionary
patron — the Duke of Edinburgh).4 In the
course of the 1990s, however, when Dr
Bird became closely involved, BTCV
moved back towards its nature therapy
roots, promoting the countryside in terms
of its supposed beneficial effects on
contemporary health problems. With
support from central and local
government, and health authorities,
BTCV has sponsored a network of ‘Green
Gym’ projects, linking exercise to
conservation.5
The nature therapy revival has also
attracted major corporate sponsorship.
BTCV enjoys the support of Rio Tinto,
formerly known as Rio Tinto Zinc, one of
the world’s most rapacious — and
environment-despoiling — mining
corporations, and Barclays Bank PLC
(from which a generation of students
withdrew their accounts because of its
involvement in imperialist exploitation in
Africa).
Natural England’s health campaign
emphasises the healing power of nature
in particular in relation to children and
those with mental illness. It claims that
nature can tackle the obesity epidemic,
prevent bullying, reduce ADHD and
improve concentration, self-discipline
and self-esteem (it is striking that modern
nature therapy only deals with
fashionable conditions). In common with
current public health policies — such as
the school meals crusade — Natural
England focuses on the sections of
society least capable of resisting the
advance of intrusive and authoritarian
health policies. Let’s hope that the
growing revolt against Jamie’s school
dinners soon extends to the ‘back to the
country’ fantasies of Natural England.
REFERENCES
1. www.naturalengland.org.uk
2. Weindling P. Health, race and German politics
between national unification and Nazism 1870–1945.
Cambridge: Cambridge University Press, 1989.
3. Patel K. Soldiers of labor: labor service in Nazi
Germany and new deal America, 1933–1945.
Cambridge: Cambridge University Press, 2005.
4. http://www2.btcv.org.uk/display/our_mission
5. http://www.greengym.org.uk/
British Journal of General Practice, December 2006
977