Social dimensions of healing: a longitudinal study of outcomes of medical management of headaches.

The social sciences have made few direct empirical contributions to the understanding of 'non-specific' benefits of treatment and generally the symbolic healing of indigenous non-Western medicine has received most attention in this field. This paper reports some results of a wider study of neurological clinics in England in which it is shown that a sample attending for headaches experienced considerable improvement in symptoms when followed up 1 year after attendance. Most of this improvement appeared not to be due to any intended treatments received at the clinics but could be attributed to the quality of patients' immediate responses to clinic attendance as assessed from reach interviews conducted after their consultations. This relationship between immediate 'satisfied' response and subsequent symptomatic improvement is interpreted in terms of the general levels of expectancy and sense of potential control achieved by obtaining referral to a specialist which directly enhanced recovery in those patients who felt the doctor's actions to be directly relevant to their personal concerns. Disappointment with the doctor reduced the 'non-specific' therapeutic benefits of the hospital referral. The intimate connections of patient satisfaction, treatment received and subsequent outcomes need more careful consideration in social studies of Western medicine.