Heroes Not Zombies

I’m using this photo of a rainbow appearing in a fountain because I think rainbows are a symbol of hope, as well as being a phenomenon which exists only in the presence of the subject (the observer), and a fountain which is symbolic for me, of the life force, that flowing healing energy which enlivens and heals us all.

Isaac Judaeus lived from 855 to 955. He was physician to the Fatimid rulers of Qairawan in Tunisia, and his works were amongst the first to be translated from Arabic into Latin at the time of the great translations which brought Arabic thought and science to the notice of the West. His books had a big influence on Western medieval medicine, still being read into the 17th century. There’s a small book of his, Guide for Physicians, which only exists in Hebrew translation, where he sets out his ethical conception of medical practice (remember this is writing from the 9th and 10th centuries). I’ve only read a few of his aphorisms, but this one, in particular, caught my eye.

Comfort the sufferer by the promise of healing, even when thou art not confident, for thus thou mayest assist his natural powers

What’s he saying here?

First of all that physicians should comfort the sufferer. Sadly, that’s an element of health care which patients don’t always experience. Shouldn’t physicians always offer care and comfort?

Secondly, they should do this “by the promise of healing”. He goes on to say “even when thou art not confident”. Wouldn’t this be deceit in some situations? One of my earliest experiences as a young doctor was admitting a very elderly, very ill lady to the ward where I worked. Her also very elderly daughters were hugging each other on the seat outside the ward, wringing their hands, crying and upset about what was happening to their mother. I thought I’d comfort them and said “Don’t worry. Your mother is in the right place now. I’m sure she will be fine” They smiled to me just as one of the nurses came out of the ward and called me aside. “That patient you just admitted doctor? She’s just died”. Well, that taught me a lesson. But it didn’t stop me practising with hope, practising with the expectation that there was a potential for things to go well. It just taught me never to assume I could accurately predict the future!

I still believe that. I believe none of us can predict the future….especially not in the case of the particular, the specific, individual circumstance. I was surprised many times throughout my career when patients did so much better than the textbooks would have predicted. So, I often thought, the truth is that as you look forward from this point in time, there are a whole range of potential paths leading from here into the future. In the situation of illness, some of those paths will be largely ones of decline, some of stumbling along, and some of steady, or sudden, improvement. And nobody, but nobody, can accurately predict which path this particular patient will take. Therefore, at each stage of the process, hope is not only possible, but is as reasonable an option as any other.

That’s what I understand about “the promise of healing” – it’s not really a promise, in the sense of a guarantee, but a potential (in the way we say something may be “full of promise”). And I think acting from that perspective contributed to the improvements patients experienced.

That’s the final part of Isaac Judaeus’s aphorism – “for thus thou mayest assist his natural powers”.

I can’t see there is any healing other than that brought about by the human being’s “natural powers”. I’d describe them now in terms of systems theory, or complexity theory. Those natural powers are the power shown in any “complex adaptive system” – the powers of self-regulation, self-defence, self-healing…..the “autopoietic” “self-making capacity” of a person.

Medical acts, medicinal substances, physicians’ interventions are only truly healing when they work with, not against, this capacity. That’s why doctors should always remain humble. It’s not what we do that heals. It’s what we stimulate and/or assist….the astonishing self-healing powers of the human being.

In contemporary thought, these “natural powers” Isaac Judaeus refers to are often wrapped up in the idea of the “placebo effect”, but, sadly, that’s a concept so entangled with ideas of trickery and deceit that the “self-healing” powers get lost in it.

So, here’s what I get from that old aphorism –

• offer comfort and care
• offer hope and the promise/potential of healing
• and in so doing assist the natural or self-healing powers found in every human being

One of my hopes for the future of Medicine would be that we learn many other ways to assist those “natural powers”.