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The Mind-Body dichotomy is a two-headed monster

We are all victims of shared misconceptions, all of us as patients and as clinicians.  We have been raised to believe that technological “miracles” will solve the problems of our lives when those problems take the shapes of diseases.  Doctors and patients share the misconception that when something is wrong, a doctor will have intricate technological means of identifying the cause of the problem and reliable technological tools to make the problem go away.

This is not “modern technology” or “scientific progress.”  This is archaic superstition, nothing more.  We are investing all our hopes in a system which makes each suffering patient powerless and ignorant, putting blind trust in the incomprehensible hocus-pocus of doctors, as if somehow doctors had power over the forces of life and death.

The main reason we act in such an irrational manner is that each of us at the core is emotionally infantile and primitive.  When we are hurt or afraid, we wish someone would take care of us without our having to understand or struggle with our own difficulties.  This capacity for emotional dependence is real and universally shared, but it can be overcome.

Another factor which leads us to treat our health in a superstitious and mysterious fashion is that it does, in fact, seem difficult to understand what happens inside our bodies.  Although discovery of some intricate and obscure detail might produce benefit, there is no good reason now that each of us should not understand in a practical fashion how we are put together and how we function as organisms and as persons.

I am not sure what constitutes health, but I know that the processes of illness are universal and unique at the same time:  Each of us has illness, has it in the same general patterns; but each of us is a unique individual and develops illness in the unique pattern of her or his own life.

How we make ourselves sick need not be a mystery.  It is difficult for us to perceive or understand because we carefully hide it from ourselves.  We are reluctant to acknowledge there is any problem.  Even when we are forced to admit there is something wrong, we make the mistake of looking for the cause when we need to look for a set of causes and the setting of the problem in our own real lives.

Psychologic clinicians often back into the mind-body dichotomy by emphasizing the psychological so intensely they risk missing the wholeness of each person as blindly as the somatician can.  Both can give the patient the false message, “It’s all in your head.”

In clinical work both clinician and patient can make good use of the ideas “psychosomatic” and “holistic”.  Even when we don’t use these words we use these ideas.  Of “psychosomatic” there are false and true notions.  The false one takes the form, “My mind gives my body pain.”  The correct notion is, “I am I:  mind and body are ideas about aspects of me.  If I hurt, it is my whole self who is hurt.”

We have begun to accept “consumerism” in our culture, the idea that you have a right to take care of yourself, to ask questions about what you pay for and about what is done to you.  You should be able to use this idea in caring for your health to get real attention and cooperation from doctors and other clinicians, but that is not always easy to accomplish.  Doctors are burdened with traditions of withholding information, or at least not making satisfactory efforts to communicate fully with patients.  Perhaps this is changing, but it will change more rapidly if patients actively seek understanding and cooperation instead of traditional passivity toward medical authority.  “Googling” for answers on the internet is a futile immersion into a sea of competing myths and sales pitches.  Caveat emptor.

Our economic crisis in health care interferes in the relationship between doctor and patient.  Patients who have no resources certainly have difficulty buying attention.  Patients who have some form of insurance tend to take a casual attitude toward costs, and therefore are less attentive to what makes sense to do.

We seem to carry in our minds a standard of health care which is a dangerous and expensive myth, something like, “If my heart wears out I can be fitted for an artificial one.”  A safer, cheaper and more practical idea is, “If I take care of myself my heart may not wear out so quickly.”  When we all at once participate in irresponsible myths our health does not improve but we spend huge resources on fruitless applications of technology.

Problems of communication, coordination and economy of health care cannot be solved by doctors alone, or even by doctors and patients together under ideal circumstances.  Several other parties enter strongly into the process:  hospitals, insurance companies, government agencies.  Doctors and patients must scrutinize these parties carefully to keep them from disrupting the clinical relationship.

Doctors do not have the power we wish they had fully to understand our bodies, minds and lives, to change them when they do not satisfy us.  Doctors do not have the power we wish they had to simplify and economize the health-care network which has become increasingly dyseconomic and counterproductive.

But in this picture I sketch, a doctor can be the closest person to any real patient and can understand and recommend in the most coherent fashion.  Any doctor who doesn’t try to understand that or doesn’t try to do it is compromising his own integrity and his patient’s welfare.

Common is the experience of being a patient.  Rarely do doctors remember what it is to be a patient.  Patients regard doctors and what they do as mysterious, powerful and incomprehensible.  Rarely do patients allow themselves to see doctors as simple, nor allow doctors to act that way.

Inthis book is a story of me and doctoring, a complex story.  I write from me as doctor’s child, patient, parent, doctor and critic of doctors.  If what I know is so, that relationships between patient and clinician can reflect all that is good and true and universal in life, that ignorance of this truth makes for death and evil, it will be reflected in my story for you to use in your own way, to be more effective as a patient, as a clinician.


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