Heroes Not Zombies

In an earlier post, I showed this page from my notebook and explained the left hand page – the one about making a diagnosis. Once we understand someone, then we can begin to help them. The right hand page is my mind map to think through some of the issues related to that.

Most diagnoses focus on the physical, measurable “disease”. This naturally leads to treatments being designed to address pathology. In acute disease this is highly relevant. If you’ve broken a leg, you want a treatment which will lead to repair of the bone. If you’ve had a heart attack, you want a treatment which will address the damage done to your heart, and so on. Most drugs and most surgical procedures are designed to do just that – they address the damages tissues and attempt to effect a repair. A repair is either the removal of a lesion, for example, a wart, or a tumour. Or it is a restoration of a necessary balance in the body eg replacing insulin in diabetes. Actually, this is a commonly misunderstood element of medicine. Drugs and operations don’t actually repair anything. They simply, at best, assist the body in effecting its own repair. It’s not the orthopaedic surgeon who heals the bone, it’s the body. Similarly, we tend to think antibiotics cure infections. They don’t. They kill bugs. It’s the body which heals the inflamed lungs, or throat, or bladder, or whatever was infected. This whole approach accounts for much of modern medical practice. It’s materialistic, reductionistic and focussed on measurements of change and definable outcomes. Yet, the misunderstanding about how healing is actually coming about means that the focus is too narrow and overplays the role of the treatment at the expense of the individual human being.

What if helping someone who is ill, is more than a matter of repairing? Well, the next part of the diagram shows how we can focus instead on resilience. By resilience I mean the human capacity to adapt and to cope. The body’s natural defences and systems of repair are a manifestion of a person’s resilience. You know how if your general energy and mood is low, your immune system is compromised and you catch more minor infections? Not only that, in such a state it takes longer to get over something. An intervention which explicitly seeks to foster resilience, fosters repair too. I think this is a concept you’ll understand very quickly, but, clinically, it’s a lot harder than repair. For a start, the contexts of someone’s life plays a big part in their resilience. We see this in work which shows how dates of deaths are often related to significant personal dates – like anniversaries, birthdays and so on. We also see this in work on the effect of the physical environment on recovery rates after operations in hospitals. Resilience is a fundamental part of self-recovery and self-repair. It’s probably a part of the explanation for placebo effects. But it is terribly poorly understood and researched – probably because there are no simple resilience drugs to be marketed!

The final part of the right hand page above is about “growth”. The most amazing result from an illness is when a patient doesn’t re-establish a status quo but where they actually become stronger and more resilient through the experience of the illness. A classic example of this is the Lance Armstrong story – “It’s Not About the Bike” – where he shows how overcoming cancer actually made him into the man who could win the Tour de France more times than any other man in history.

What interventions would explicitly support and encourage growth? Well, that’s even more complex than the resilience issue and even more personal and individual.

But I think that’s our challenge.

I think we need to develop systems of health care which explicitly address the issues of resilience and growth. If we don’t do that, we just end up fire fighting again and again and again. We don’t want to just fight infections, we want to develop people’s capacity to remain healthy and well-defended against infection and other diseases.

So, here’s my wondering and, I hope, some of you will wonder about this too – what would a health service look like if it was more than a repair service? What would we do to encourage and support resilience and growth?