First, a new term for your consideration: The Sovereign Interior of a person.

What do I mean by 'The Sovereign Interior'? I mean that inner part of ourself which cannot be seen by anyone else except ourself and our Creator, God. I have thought about using the word soul but decided against it because I'd like to present an argument without the many different understandings of soul. By using the word Sovereign Interior for the purposes of this page,

We may use words to express that inner part of ourself, but it is still only an attempt at expressing that part of our self. It's the part of each of us which knows and can discern right from wrong, and is the source of our emotions, great joy and immense grief. It's also the part which reports dangers to us, for example, in the form of anxious feelings, or panic.

It's also the part of us which creates - my own Sovereign Interior is typing this sentence on my laptop, My fingers may be doing the tapping of key, but it's my inner self who's deciding what words to write, before my fingers tap the keys.

In times gone past, the concept of health automatically included our Sovereign Interiors. Doctors has full autonomy and professional jusgement and were able to consider the whole person and prescribe things to soothe and heal the soul as well as the body.

Now imagine what life would be like if we didn't have a Sovereign Interior.

'Health' as it presently exists as a publicly funded service, doesn't recognise the Sovereign Interior of people.

From the point of view of health administration, the only aspects of human health which exist are those aspects which can be observed and recorded on a line of a spreadsheet, for the purposes of accounting and auditing the expenditure of public money, which pays for the provision of health services.

Matters of The Sovereign Interior — such as, for example, the distress which accompanies not being believed about one's history — cannot be 'legibilised' by health administrators. What they can see is distress. But too often they cannot see the cause of that distress with sufficient clarity or confidence to be able to believe it themselves, and write it as an entry onto a medical record. Their own medical training cautions them not to be deceived by patients, otherwise they may be liable in some way.

And so the system proceeds as though there is no such thing as a Sovereign Interior — and that is only because it cannot be made legible on a spreadsheet by the machinery of accounting and auditing.

But Another Human Being Can See It

But another human being can see it. Especially if that other person has had a similar experience, one which has induced a particular kind of suffering.

This isn't a lesser kind of knowing. It is a different kind. Recognition is real. It is how most of medicine actually worked for most of its history, and it is how every person who has ever been believed came to be believed.

But it lives inside a relationship, and it does not survive being extracted from one. Write it down, and what is left on the page is not the knowledge — it is a report of the knowledge, and it will be read as an opinion.

Which is why the shortening of the consultation, the loss of the doctor who has known the family for twenty years, and the arrival of the next available clinician instead of your own, are not small administrative matters. On the spreadsheet they are efficiencies. In reality they are the removal of the only faculty which could see what the instrument cannot.

The System Is Not Blind

Why is health administration so blind to the Sovereign Interiors of humans?

I want to put this more precisely, because I do not think blindness is the right word. A blind system cannot see. This system has eyes — every doctor and nurse in it is a human being capable of recognising another. What it has done is make it unsafe for those eyes to report what they see. A clinician who believes a patient, and records that belief without evidence which would satisfy an auditor, has exposed themselves. So belief becomes a liability, and the safest professional act is not to see.

The system is not blind. It has been built so that its eyes cannot report.

But that only pushes the question back one step. Why has it been built this way?

Because state health administration is governed and regulated by commercial logic.

Where The Commercial Logic Came From

In 1989, The Public Finance Act changed what public money is voted to. Parliament stopped appropriating funds to organisations for purposes, and began appropriating them against classes of outputs — things which can be specified in advance, delivered, counted, reported and audited.

In 1993, The Health and Disability Services Act applied that logic to health directly: twenty-three Crown Health Enterprises, run on a commercial footing, selling their services to purchasing authorities. The hospital became a firm.

What The Account Gains

There is a second half to this, and it is less often said.

The account does not merely lose part of health. It also gains a body of material which is not health at all. Bed-days. Throughput. Waiting list movement. Six-hour target attainment. Coding compliance. FTE utilisation. Every one of these is legible, funded, audited, and reported to Parliament. Not one of them is a person being well.

So the account is smaller than health in one direction, and larger than it in another. Which means a health system can improve every single number it holds while the people inside it get sicker — and nothing in the accounts will register the contradiction, because the accounts contain no term for the contradiction.

And because what is measured is what is rewarded, effort drifts, year after year, toward whichever activities make performance visible. The better the system performs against itself, the further it travels from health. This requires no bad actor anywhere in it. It is the arithmetic working exactly as designed.

The Objection, Answered Before It Is Raised

It will be said that all of this was undone — that the Crown Health Enterprises became Hospital and Health Services in 1998, that District Health Boards were non-profit from 2001, that Te Whatu Ora replaced them in 2022. All of that is true, and none of it touches the argument.

What was undone was the governance label. What was never undone was the accounting frame. Money is still appropriated against outputs which can be specified, counted and audited. The Public Finance Act 1989 is still in force. The ledger outlasted every restructure built on top of it.

What, Then, Has Health Become?

But this raises a question. What is 'health' if it ignores the Sovereign Interiors of human beings, and the suffering which takes place deep inside a person? If 'health' loses its first principles, what has it become?

The domain of health never used to be ordered by commercial logic. It used to be understood as a 'common good'. It used to be — and still is, in some cases — an arm of the church, meaning that it was supported financially by the church, without any commercial logic, for the good of the whole civilisation.

Where did this drive to impose commercial logic onto health come from? This question goes deep, and it needs to be examined and untangled before we can begin to see the full picture and context of 'mental health', 'health', and more.

The Two Pictures Of Health

[Figure: The Two Pictures Of Health]

These two ideas do not resolve into one diagram. They resolve into two, and the pairing is the finding.

In the first picture, health is the whole actual condition of a human being. Inside it sit two ways of knowing: The Legible — what an instrument, a measure or a form can capture, knowledge which survives being written down and read later by a stranger — and The Witnessed — what one person can know of another by being present to them over time. They overlap, but neither contains the other. And together they do not exhaust the person. What remains is The Sovereign Interior.

In the second picture, the same territory is drawn as The Account holds it. The Sovereign Interior has no box, and so, officially, it does not exist. The Witnessed has no box either. And sitting inside The Account, occupying the place where health should be, is all the counted material which is not health at all.

The whole of it reduces to a single false statement of identity: health equals the account — when in truth the overlap between them is smaller than either one.

Questions For You

If these kinds of questions interest you, please further consider:

What is health in the context of a single human being?

What is health in the context of a community, a society, a nation?

Does health have 'facets'? If so, what are they?

Where does 'health' come from?

What criteria need to be met, in each of the above cases, in order for each of them to be described as 'healthy'?

Is it possible to systematise and legibilise 'health' to meet the ingredients for commercial logic?

I am asking these questions in a Socratic manner, in an attempt to reveal the inconsistencies between:

'health' from first principles, and

a 'system of health' anchored in commercial logic.

A Final Question, For The Moment

What are the possible societal and individual consequences of a system of health which forces human doctors and medical staff into a system which is itself unable to see into the Sovereign Interiors of the people who come to them for help?

I will begin the answer, and leave the rest to you.

A code must be entered.

That is the whole mechanism, and it is worth sitting with. The consultation has to end in a record. There is no billable code for I believe this person, and I do not yet know why they are suffering. But there is an abundant, well-established, fully fundable family of codes for suffering without a demonstrated cause.

So the system does not discard illegible suffering. It converts it. It takes distress whose cause it cannot see, and renders it legible in the only shape the field will accept. Not through malice, and not occasionally — routinely, because the alternative is not an available output, and outputs are what the institution exists to produce.

And then the record becomes more real than the person. Every clinician after the first one reads the file before meeting the patient. The person now has to argue against their own record — and arguing against your own record is itself a legible symptom. It codes. And the code strengthens the file.

That is the trap. Resistance to the classification is admitted as evidence for the classification, and there is no move available from inside the system's own terms. The only exit is to step outside those terms and ask the prior question: on what authority?

Witness does not stop being needed when it stops being funded. It migrates. It goes wherever it can still be held — to families, to friends, to churches, to advocates. To a person who will read two hundred and fifty-one pages of somebody else's file, and believe them.

The Name Of This Website

The name of this website is Ange's: CTE Matters to Me.

Please read it slowly, because everything above is already inside it. She didn't write 'CTE Matters'. A claim about the world can be weighed, funded, or refused by somebody with a spreadsheet. She wrote to Me — and there is no field on any form in this country for to me.

It cannot be entered, coded, audited or denied. Not because anyone is being cruel about it, but because the system's writ does not reach the place the sentence is spoken from.

It is not an argument. It cannot be refuted, because it was never a claim about the world in the first place. It is testimony from inside The Sovereign Interior.

She said it. I am carrying it. That is what this website is: a witness structure, built outside a system which has forbidden its own agents to witness.

All Glory to God.

CTE Matters To Me

CTE Matters To Me

Contact

Please feel free to send us an email or phone us. ThankyouAnge Murtha and Elisabeth Cave

Please feel free to send us an email or phone us. Thankyou
Ange Murtha and Elisabeth Cave