The Limits of Modern Medicine: Frontiers of Healing
On the Surface some moments in life appear uneventful. When revisited, from the perspective of intervening years, they assume a meaning of great importance. Such a moment, etched as an image on my mind, occurred the afternoon of my first day in medical school.
On that particular day, the entering students, all one hundred of us, were taken as a group to the local Veterans Administration hospital. We marched proudly into the auditorium, sat down in hushed anticipation, and the dean of students said, "We are going to bring in your first patient." An elderly man in a bathrobe was led to the center of the stage. Addressing us, the dean said, "Tell me what disease this man has."
There was a second of silence, and then our questions started popping. We wanted to know if the man had a pain here, a pain there. The man answered all kinds of questions as best he could. He was direct and succinct; he must have had some experience with such demonstrations. After fifteen minutes one of the students made the diagnosis: "He has an ulcer."
The dean nodded with pride. "Yes, he does.... That is wonderful! See how good you already are as physicians, and you have not even gone through medical school."
So here was the first lesson I learned as a doctor-to-be: ask for symptoms, make a diagnosis, and treat the symptoms. From those first moments in medical school I learned to focus on disease rather than health, pathology rather than the person, parts rather than the whole, an ulcer rather than an ulcerated life.
During the next four years, we learned to perfect our skills in this area: to take a medical history, perform examinations, differentiate among a constellation of symptoms, and, of course, treat the disease or ailment. When we graduated, we were the products of an expensive, thorough, and excellent education in the treatment of disease. We had an ever-expanding technical arsenal and a knowledge of hundreds of drugs to help us treat the sick.
We traveled across the country to internships and residencies. Finally, the day came; our training was complete, and we began to practice medicine. In private practice, at a university, or in a health plan, we were ready for our first patients.
The Patient Gets Trained, Too
As a consumer of medical care, you receive training, too. You have learned that, if you are troubled or ill and in need of diagnosis and treatment, you must first check your health insurance card and then call your health plan or physician's of lice an appointment. The physician you call will likely be a primary-care physician or a specialist limiting his or her practice to a specific anatomical area: foot, nears, bone, etc. Your ticket of admission is a symptom, preferably a physical symptom. Those symptoms that receive the most urgent attention involve blood, pain, or a lump. You leave for your appointment with a mixture of apprehension, expectation, and relief. The office, more than likely in a nondescript sterile building furnished with generic tables, chairs, and outdated magazines, is watched over by the office staff, who are well separated from you by an impenetrable glass wall.
When your turn arrives, you enter the doctor's consultation room, nervously find your chair and take note of the diplomas and licensure conspicuously placed on the wall. Each testifies to the training and professional status of the physician, assuring you that the physician is scientifically trained, tested, and certified.
The physician enters. He or she checks your chart, nods in your direction and asks, "What's wrong?" More than likely, you will relate the events leading to your visit with a focus on physical symptoms. Listening to your history, your physician, trained to synthesize these symptoms into categories called symptom complexes, which identify specific diseases, leads you into the examination room to complete a physical examination, which may include blood and urine tests, an electrocardiogram, and, potentially, a variety of other appropriate procedures or tests.
Your symptoms and examination findings may result in an interim diagnosis or a specific therapy. However, further tests or the opinion of another specialist may be required. If all the tests are normal, and your symptoms are nonspecific, you will be reassured, dismissed, and considered one of the "worried well" (a term used by health professionals to describe individuals who feel unhealthy but whose physical examination and laboratory tests are normal).
If therapy is initiated, you will be expected to comply with the recommendations and report back any side effects, as well as the outcome of treatment. If treatment is successful, your symptoms will regress, and you will return to life as usual, interacting with the physician only when another problem emerges to disturb your normal activities or body feelings. For the most part, this is the way healing is done today.
Temple Healing: A Lesson from the Past
How far have we come from our ancient healing practices? If you had lived in 500 B.C. and were ill or troubled, physically or emotionally, and in need of healing, you would have journeyed to Cos, Epidaurus, Pergamon, or one of the many other temples of the ancient Greek healing god, Aesclepias.* You would have participated in practices that continued without interruption from 500 B.C to 300 A.D. throughout Europe, the Near East, and the Mediterranean, where temple medicine was the foremost source of healing.
Your decision to journey to the temple would not be made lightly; healing was a sacred process—a communion with self and the gods. After consulting friends and physician, you would prepare to leave for the healing temple. The journey of several days would be interrupted with stories of miracle cures from those returning home. With rising hope and expectation you arrive at the temple gates. Here you would read testimonials etched in stone, such as:
Believe me, men, I have been dead all the years I have been alive. The beautiful, the good, the holy, the evil were all the same to me; such it seems was the darkness that formerly enveloped my understanding and concealed and hid from me all these things. But now that I have come here, I have become alive, as if I had laid down in the temple of Aesclepias and been saved. I walk, I talk, I think. The sun so great, so beautiful. I have now discovered men, for the first time now I see the clear sky, you, the air, the acropolis, the theater. [Papyrus Didotrana (approximately 360 B.C.)]
. . . lame. He came as a supplicant, to the sanctuary on a stretcher. In his sleep he saw a vision. It seemed to him that the God broke his crutch and ordered him to get a ladder and climb as high as possible. He dared to carry it out . . . and walked out unhurt. (fourth century B.C.)
Upon your arrival you would begin the process of purification through cleansing and fasting; a symbolic shedding of toxic attitudes and the unhealthy habits of daily life. At this point, you would become part of a dynamic and varied healing environment. Walking in the temple grounds, you would enjoy the beautiful gardens and the graceful and serene statues of the great Greek sculptors Phidias and Praxiteles. Roaming minstrels would lift your spirit, and you would participate in lively philosophical dialogues that would stimulate your intellect and challenge you to consider alternate perspectives to your current life situation.
You might attend dramatic performances such as the tragedies of Aeschylus, Euripides, or Sophocles, which portray the cycles and rhythms of human life and teach that we share life and human nature with our fellow humans, suffering together our pain and distress as part of life's movement toward knowledge, maturity, and healing; or you might have a massage, participate in an athletic competition, or consult the priests regarding diet or the use of herbs or pharmaceuticals of the time.
Each evening, dressed in your ceremonial white robes, you would gather with others in the sacred temple to leave offerings to Aesclepias as you bid him to visit you at night with a healing dream. In the morning, you or some other petitioner may awake healed. Others might relate the content of their dreams to priests who would assist in interpretation and provide instruction in dieting and the use of medicinals.
Day after day, removed from the stress and pulls of daily life, focusing on diet, fitness, relaxation, and self-examination, you would experience a slow return of energy and vitality. Finally, the day would arrive when you felt restored with a sense of wholeness, balance, and harmony, ready for your return home. Immersed in activities for mind, body, and spirit, you would have learned about yourself and developed new attitudes and behaviors-healthy, life-supporting ones.
As illogical as it may seem to our scientific minds, we can accept that many of the visitors to the temples returned home with renewed health. The continued existence of the temples for eight hundred years, the personal testimonials of healings, and the written words of the great philosophers and writers of ancient Greece support this conclusion. Some may have returned to health as a result of the natural history of their disease, others may have improved from the relaxed environment, pharmaceuticals, exercise, nutritional practices, community support, a shift in perspective, and the inevitable healing that comes from the release of the tensions of daily life.
Of greater significance is the fundamental approach of the healing temples, which viewed the individual as a whole person and emphasized the interactive unity of mind and body. Neither mind nor body was treated alone. Both were considered as aspects of the total human organism, the mind-body. This holistic view, an essential aspect of Greek humanism, allowed a natural evolution of holistic healing practices using science, the arts, philosophy, humor, and spirituality to replace stress with harmony, anger with peace, despair with hope, mental paralysis with possibility, and isolation with community.
Lacking a technical knowledge of physical diagnosis and therapy, the ancient practitioners of medicine were compelled to use their understanding of the human mind and spirit to heal the body. The individual-his or her attitudes, beliefs, and behavior-were inescapably central to the healing process.
Is Ancient History Revisiting Us?
You do not have to go very far from your own home to rediscover in modern society the essential elements of the Aescelpian healing temples. Every day, in a church, school, or other meeting area in your community, you can visit an Alcoholics Anonymous (AA) meeting with the million or so others who do so each day around the world. It is ironic that, twenty-five hundred years after Aesclepias, alcoholism, a disease that accounts for a substantial number of hospitalizations and deaths in twentieth-century America, is best treated through the twelve-step spiritual cure of AA. Alcoholics and their physicians, unable to successfully treat or heal this disease with all of the technology of modern medicine, rejoin their Aesclepian ancestors in turning to a more holistic approach.
The principles of AA, which are now extended to many similar groups coping with a variety of disorders, emphasize a disciplined and committed process of recovery through self-directed actions that range from self-investigation and life-style change to attitudinal healing and conscious living. The reader may respond by saying, "This is an emotional problem." Ask an alcoholic. It is a mind-body problem.
Another good example of the bridging of mind and body was reported in a 1977 issue of the Journal of The American Medical Association (JAMA).1 A Philippine-American suffering from a severe case of lupus, a disease involving many parts of the body, became despondent with the progression of her illness, which seemed unresponsive to medications. There could be no question, according to the report, of the severity of her disease, the involvement of multiple body organs, or the progressive advancement of her disease even while she was on the most powerful medications. She returned to her native village seeking further help with the disease. Two weeks later, following the removal of a curse by a local witch doctor, she arrived back in her American physician's office apparently cured. To her physician's amazement she did not even suffer the usual withdrawal symptoms from her powerful medicines. Five years later she remained completely disease free.
Although this case was reported in a major medical journal, it was likely considered by most physicians as an interesting anomaly. This, despite the fact, that many similar reports can be found in the medical literature. It is ironic that we are so absorbed with miracles of another kind, modern technology, that we have lost trust, faith, and knowledge of the extraordinary healing powers of the human mind, body, and spirit. As we have invested in the miracle of technology, we have disinvested in the miracle of our humanness.
In this new age of scientific wonders, technology makes it possible for us to attain precise pictures of the inner workings of the human body, measure infinitesimal metabolic reactions, exchange organs from one person to another, grow babies in test tubes, and maintain physiologic life when all signs of human life are gone. Our approach to health and disease has resulted in diagnostic and therapeutic capacities that are unparalleled in human history. These achievements have enabled us to alter successfully the natural history of many diseases and to provide helpful treatment in others. Nothing can detract from these accomplishments. Yet scientific medicine is at its limits when confronting degenerative and stress-related diseases, which are more related to the way we think and live than to bacteria, viruses, and toxins. These problems of living cannot be analyzed under a microscope, cured with medicines, excised with a scalpel or eliminated through organ transplants. They cannot be reduced to biophysiology or comprehended by separate medical specialities.
Consider John's "medical problem." He is thirty-four years old. He came to my office with the understanding that I work with certain medical problems in a different way. For the past five years, he had been suffering with moderate symptoms from a disease called ulcerative colitis, a chronic, recurrent ulceration of the colon. He had been on a variety of medications, at times responding so that he was free of symptoms for many months at a time. Nevertheless, he continued to suffer with no permanent end to the problem in sight, even though he had received good medical care and was treated with proper medications.
The exacerbations and remissions of his illness were consistent with the medical understanding of this problem and with the acknowledged fact that there was no cure for his disease, only treatment. He had reached the limits of conventional medicine's capacity to improve his disease, and was instructed to use the medicines as needed and live with it as best as possible. That, however, was not good enough for John. He wanted to be healed.
In our meeting, I discussed with John the mind-body approach to illness and the effort it would require of him. I asked him if he would be willing to work with me in looking at his illness from a different perspective; a self-healing perspective that expands upon conventional treatment. He agreed. I explained to him that it would be helpful to use a relaxation technique, which clears the mind and allows access to hidden information stored in the mind, and mental imagery, which often assists in bringing this information to awareness. I instructed and guided John into deep relaxation. When I could observe through his breathing, complexion, and body posture that he had entered a relaxed state, I began the visual imagery.
I asked him to visualize an image of his colon as he imagined it would look.
"It is red, raw, and has ulcers scattered throughout," he stated.
Asking him to hold that image firmly in his mind, I then requested his patience as we began a magical, and, what may seem peculiar, conversation with his colon. "Ask your colon," I stated, "what it needs to tell you."
After several minutes he replied, "There is no answer."
I explained to him that talking to the colon in imagination is different from talking to a real live friend. He must wait quietly with patience, always in communion with this part of his body, awaiting the answer that may come in a verbal or nonverbal manner.
After several minutes of waiting, he stated, "It wants peace, quiet, and harmony." Anxiously, he then stated, "I am beginning to feel tense."
I asked him to stay with the feeling of tenseness and tightness and intensify it to increase his awareness of this feeling. "Ask your colon when all this tenseness began," I said.
His answer came surprisingly quickly. "Twenty five years ago."
I noted that his colon must have been very patient with him for all those years. Tearfully, he slowly began to access the important information hidden in his mind.
"We were not supposed to feel angry, express feelings, or disturb anyone. We were taught to be proper, pleasing.... I need to express my anger.... I need to be able to say no when I feel no.... I need to be able to express and care for my needs."
At this point, his agitation diminishing, he sighed with apparent relief, and slowly returned to a more relaxed state. After several moments of quiet, I asked him to check with his colon to see if he had it correct. "It says yes," he responded.
"Work out a contract with your colon," I told him, further explaining that this was a symbolic contract; a commitment to "listen" and respond to the physiologic needs of his body.
"I will work on these issues if my colon will be patient with me."
He opened his eyes, metaphorically as well as physically, and we planned the next few visits and the work ahead. His disease could not be understood from either an exclusively physical or psychological perspective. An internist would have focused on his colon, a psychologist on his mind. Mind-body healing does not make this distinction. People do not come as parts.
John, intermittently disabled by his illness, had needed the treatment available through conventional medicine to reduce his symptoms and allow him to return to work and his daily activities. He wanted, however, more than treatment. He wanted to go beyond a reduction of his symptoms, he wanted to return to full health. As we will see later, John chose to begin a program of self-healing.
Treatment or Healing?
My medical school teachers never raised this question. I learned to treat illness: to match the right drug to a set of symptoms; to expect patients to comply with instructions and behave passively; to measure success by reduction in symptoms, results of laboratory tests, or duration of hospital stay. This was a technology of treatment using external agents or interventions, drugs, surgery, radiation, or physical therapy. There was no instruction in stress management, nutrition, or exercise÷ techniques for healing that use our natural capabilities; nor did it include the art of listening and learning about the individual being treated. Most notably, our instruction completely lacked any reference to the capacity of the human mind and body to self-heal.
As a young physician, I began my career at a large HMO. I soon became proficient at seeing many patients each day. As I gained experience practicing medicine, I discovered that conventional treatment, what I was taught in medical school, was ineffective at permanently relieving the symptoms I was treating. My patients were frequently returning with the same or related problems, most often resulting from stress and unhealthy life-styles. After several years, I began to feel overwhelmed, stressed, and fatigued from practicing a treatment oriented medicine that was working for neither my patients nor myself. So, I began to explore alternatives to the treatment model and soon discovered that treatment and healing were not the same. Attempting to sort through these issues, I began by clarifying the difference be between the two approaches.
Treatment is the use of an outside agent, or power, usually in the form of medication, surgery, radiation, or physical therapy, to manipulate the physical body with the goal of reducing or eliminating the signs and symptoms of disease. Healing is the use of the inner power and resources of our mind and body to restore our own unique balance and harmony. It is this balance and harmony that results in full health and gives us the ability to live lives of vitality and joy.
The sophisticated hard technology of treatment is a sharp contrast to the soft technology of mind-body healing. Consider the setting in which each occurs. Treatment is based in the doctor's office or a hospital, usually busy, loud, and intrusive environments. Healing requires solitude, a natural, comfortable, peaceful setting, and nonurgent time for self-reflection, learning, gradual change, and the experience of balance and harmony.
By emphasizing the expertise of the physician in matters pertaining to health the treatment model delegitimizes the essential role of the individual in his or her own healing. This results in the loss of selfhealing skills and, even worse, a lack of awareness that there is more to health than the absence of the signs or symptoms of illness. In this manner, the treatment model may at times, in the long term, place the individual at an increased risk for illness. In contrast, the healing model views the individual as central to his or her healing, and aspires to a broader vision of health and well-being.
Treatment is expensive, invasive, and often rife with side effects that, at times, may be worse than the disease being treated. Healing requires the commitment and willingness to allocate time to oneself and to give priority to full health. It is self-directed, natural rather than imposed, and, unlike some effects of treatment, the effects of healing can only be positive. As treatment is directed at the reduction and elimination of symptoms, and infrequently at actual cure, healing is directed at mobilizing the mind and body to enhance the natural defenses, accelerate recovery from illness, and promote full health. It is directed at the early, subtle, and fundamental sources of distress that lend themselves to selfregulation. This includes the following: 1) emotional distress resulting from unresolved and unhealthy feelings of powerlessness, deprivation, loneliness, and inadequacy and 2) unhealthy behaviors and life-styles. These early warning signs of imbalance are precursors of mind-body stress that, inevitably, when unheeded, lead to overt disease.
These are not exciting and dramatic issues that call upon trauma centers, intensive care, and the technological mastery of organ transplantation. These are soft issues that, when unabated over time, can be the cause of profound physiologic disturbances that may set the stage for the future breakthrough of illness. Yet, even though waiting until illness presents itself at a late stage is the most expensive form of medical care, crisis care continues to be our exclusive approach to health and disease.
The urgency of crisis, when illness has reached a level of severe mind-body imbalance, requires treatment. This is not a time for subtle, long-term self-healing that requires a consciousness and presence that is possible for very few individuals at a time of great pain and distress. Instead, crisis is usually a time to choose available treatment technologies and to allow a physician to assume the role of expert and, with sensitivity and skill, direct therapy for the malfunctioning organ or system until the immediate crisis is over and self-healing practices can be initiated.
The differences in these two approaches to health and disease are dramatic, and yet they are complementary:
Used in crisis
Goal is the absence of signs or symptoms of disease
Goal is experiencing full health, wholeness
Expanding on treatment to include healing, shifting from professional direction to self-regulation, from an emphasis on the absence of symptoms to a focus on full health is as revolutionary to contemporary medicine as was the introduction of antibiotics in the 1940s. Change, however, is certain as new research findings substantiate the age-old knowledge of the self-healing powers of the mind and body.
The Wellness and Holistic Movements
The past two decades have produced an explosion of ideas and practices claiming to fill the void left by the limitations of modern medicine. The divergence of ideas at times has seemed confusing, yet, from a long perspective, they contribute to the emergence of a new model for health and healing.
For example, in the late 1970s, John Travis opened the first wellness center in Mill Valley, California. His inspiration came from a book written by Halbert Dunn in the 1950s, based on a series of radio talks, entitled High Level Wellness. Travis believed wellness to be an educational process through which a committed individual could assume personal responsibility for enhancing well-being. Wellness was not the absence of illness but the presence of happiness, purpose in life, satisfying work, joyful relationships, a healthy body and living environment.
This idea of getting educated for one's own health caught on with the general public, who saw an alternative to the traditional medical model, which neither included a role for personal initiative, nor concerned itself with positive well-being or pro-active prevention. In the 1980s, corporations moved rapidly into wellness as a way to express concern for their employees, boost morale, potentially moderate the escalating costs of health care, and reduce the costs to the employer resulting from poor employee fitness and its effect on absenteeism, disability, worker turnover, and productivity.
Hospitals, too, entered the wellness business to enhance their public image and diversify their sources of income. Fitness centers, health-food stores, and an endless series of books and audio- and videotapes compete for a percentage of this new market.
Wellness is, in fact, an established national movement. More than 50 percent of our population actively exercises, smoking has decreased in the past three decades by 50 percent, health-food stores have expanded from twelve hundred in 1968 to eighty-three hundred in 1981, and more than five hundred major corporations offer fitness programs managed by full-time fitness directors.
In the meantime, over the past decade, in the health community, if you were not a wellness practitioner, you were probably a holistic practitioner. Holism, as a concept dates back to a 1926 book entitled Holism and Evolution by Jan Smuts. Smuts challenged the reductionist view of medical science, which denies the complexity and multidimensionality of the human experience. He supported the idea that the whole cannot be understood by summing up the parts.
Holism, as conventionally understood, states that mind, body, and spirit are inseparable. Holistic healing expands this perspective to include an understanding of individual's attitudes, beliefs, values, support system, and environments. Such a comprehensive understanding of the causative factors in health and disease, results in more effective healing.
Hippocrates, the father of western medicine, stated much the same in his treatise Air, Water, and Places. He taught his students to assess carefully their clients' living environment for an understanding of their diseases. Two-and-a-half millennia later, the noted internist, Sir William Osler, stated, "It is better to know the patient that has the disease than the disease that has the patient."
Holistic healers focus on the individual, not the disease. They listen carefully, aim for an in-depth understanding of the human lives with which they work, and enlist the individual as a partner in a healing program, which encompasses mind, body, and spirit. This approach demands of the healer that he or she be personally committed to the healing process.
How have the wellness movement and holism filled the gap left by the traditional medical care system? The answer, unfortunately, is not very well. As initially conceptualized by Travis, wellness was about personal growth and development. His focus was on generating positive attitudes, emotional well-being, healthy human relationships, community, spirituality, and joy. Poured into the funnel of our physically oriented culture, it came out as nutrition, fitness, and smoking cessation taught by exercise physiologists, nutritionists, and health educators, each trained within the constraints of their narrow specialty. The emphasis on mind and spirit, essential to the core of the wellness philosophy, was lost in its commercialization.
The implementation of holism, too, has left much to be desired. Rather than encouraging the evolution of well trained, mature, and eclectic healers, we have many poorly and narrowly trained individuals hawking one alternative treatment program or another, which, at best, may be helpful while causing no harm and, at worst, may be dangerous.
Yet, although the response to the expanding gap in our medical treatment model has been filled by neither the wellness or holistic movements, each of these attempts to expand the conventional medical model has provided new perspectives and opened the way for the ultimate emergence of a new and credible model for health and healing. We will read about such a model in the next chapters.
*I was first introduced to Aesclepian healing by Dr. Jean Houston. 1. Kirkpatrick, Richard A. "Witchcraft and Lupus Erythematosus." JAMA, vol. 245, no. 19, May 1981.