Heroes Not Zombies

Maybe, like me, you have a collection of “significant” books. By that, I mean books which had a big impact on the way you think, or the way you understand life. I’ve written about some of those books here already, but here’s another one which I read a few years ago. Hans-Georg Gadamer‘s “The Enigma of Health: The Art of Healing in a Scientific Age” is a collection of essays by this professor of hermeneutics (I know, I had to look it up in a dictionary too, but, trust me, this man had a brilliant mind!)

Gadamer died in 2002, and while I was visiting Tokyo, a copy of the Japan Times slid under my hotel room door early one morning, included an obituary about him. I’d never heard of him, but it’s amazing what you’ll read in the wee small hours in a foreign country when your body and your head are still half a day away in your home town! I was completely fascinated with what I read and his thinking about health really captured my imagination so I went online and ordered up “The Enigma of Health” from Amazon. By the time I got back home it was waiting for me. Let me share a few quotes with you. I wrote them down in my Moleskine (as I do!)

Although health is naturally the goal of the doctor’s activity, it is not actually ‘made’ by the doctor.

I make this point with every new patient I see. It’s the big unspoken truth about medical practice. Doctors’ treatments might reduce or remove a pathology, might even redress an inner imbalance, but they don’t cure – only the body does that. He says more about here –

Yet the goal of the art of medicine is to heal the patient and it is clear that healing does not lie within the jurisdiction of the doctor but rather of nature. Doctors know that they are only in a position to provide ancillary help to nature.

Franklin put it another way when he said “God heals and the doctor takes the fees”

I often ask medical students to tell me the answer to this – if a patient with a urinary tract infection gives a urine sample which grows bacteria which the lab shows are sensitive to a particular antibiotic and the patient is prescribed that antibiotic, what will the antibiotic do? The ones who don’t think carefully say the antibiotic will cure the infection. It won’t. It’ll kill the bugs. That’s it. The inflamed bladder wall, which might even be bleeding from the effects of the infection will be restored completely by the body’s repair processes. The healing is natural. The antibiotic only removes the offending bug to let the healing system do its job. This might seem like nit-picking, but it isn’t. It involves a profound change in thinking. Doctors aren’t gods. At best they assist healing and all healing is a natural process.

…the doctor’s power of persuasion as well as the trust and the co-operation of the patient constitute essential therapeutic factors which belong to a wholly different dimension than that of the physico-chemical influences of medications upon the organism or of ‘medical intervention’.

There are some who think that health and illness can be understood in purely physical terms and that treatments can be understood to work, or not work, on the basis of their physico-chemical effects. That’s a limited way of thinking. Healing involves more than that, and may not even involve any physico-chemical intervention at all. Those who think medicine can be reduced to a science (as opposed to a science and an art) rely on measurements of phenomena. Gadamer is brilliant about this –

….modern science has come to regard the results of such measuring procedures as the real facts which it must seek to order and collect. But the data provided in this way only reflect conventionally established criteria brought to the phenomena from without. They are always our own criteria which we impose on the thing we wish to measure.

I believe it was Max Planck who said “facts are what can be measured”. Well, reality cannot be reduced to facts. The tendency to reduce understanding to physical measurements is accompanied by a concept of health as some kind of product – an end point or state which can be known and measured. Gadamer argues instead –

…physicians do not simply create a product when they succeed in healing someone. Rather, health depends on many different factors and the final goal is not so much regaining health itself as enabling patients once again to enjoy the role they had previously fulfilled in their everyday lives.

This clear statement suggests to us that health is an experience and it’s an experience which in its detail will be different for every person depending on the characteristics and environments of their lives. Later in his essays Gadamer considers how far from being a measurable product, health is really what is experienced when illness is not present or goes away. This is the “enigma” of health – that we only know it by its absence. Consider the fingers of your right hand. Right now you’re not really aware of them. Trap them in a car door and then you instantly become aware of them. You get the idea?

This post could go on forever! I’ll stop, but suffice it to say this is a deeply thoughtful consideration of our concepts of health, illness and healing.