Heroes Not Zombies

I was recently sent a copy of an article published in Norway back in 2011. The article’s title is “The human biology – saturated with experience“. Here’s the summary –

SUMMARY

Background. Human beings are reflective, meaning-seeking, relational and purposeful organisms. Although experiences associated with such traits are of paramount importance for the development of health and disease, medical science has so far failed to integrate these phenomena into a coherent theoretical framework.

Material and method. We present a theory-driven synthesis of new scientific knowledge from a number of disciplines, including epigenetics, psycho-neuro-endocrino-immunology, stress research and systems biology, based on articles in recognised scientific journals and other academic works. The scientific sources have been deliberately chosen to provide insight into the interaction between existential conditions in the widest sense (biography) and biomolecular processes in the body (biology).

Results. The human organism literally incorporates biographical information which includes experienced meaning and relations. Knowledge from epigenetics illustrates the fundamental biological potential for contextual adaptation. Intriguingly, different types of existential stresses can enhance disease susceptibility through disturbances to human physiological adaptation systems, mediated in part through structural influences on the brain. Experiences of support, recognition and belonging, on the other hand, can help to strengthen or restore a state of health.

It’s a fascinating review of research literature on the links between “biography” – an individual’s unique story, and “biology” – the biomolecular processes of the body. It seems clearer to me than ever that talk of “mind and body” as if these are two separate entities is both unhelpful and misguided.

We are certainly “reflective, meaning-seeking, relational and purposeful organisms” and it’s long seemed to me that to practice medicine without that understanding demeans both patients and practitioners. Human beings are not objects which can be reduced to genes, molecules or cells. We are complex adaptive organisms with consciousness. As these authors say, we have  –

a capacity for self-reflection, for designing sophisticated symbolic structures, for attaching metaphorical concepts to experiences and for building models and categories with the aid of the imagination.

We create art, music, poetry and stories. We play. We make sense of our daily lives. (See my recent series of posts on re-enchanting life for more about these very human activities) We connect. We live embedded in a mesh of relationships. We use language, myths and symbols to interpret and experience the world.

Unfortunately, such experience does not lend itself easily to standardised interpretation; it is always an experience of something for someone, in a unique context

All of our experiences are personal and unique. To be fully human, to really understand another person, we must consider the personal and unique. My contention is that we must not only consider it, but must hold that focus as central come what may.

Yet, as these authors point out, contemporary “evidence based” approaches to medicine have failed to include the subjective –

Human subjectivity is not only absent from contemporary evidence-based medicine, it is in fact explicitly eliminated by the mathematical analyses performed during assembly of evidence.

Should we allow statistics and “controlled” de-humanised research (with the experiences of the human beings who are the subjects of the research removed) be our “gold standard”? We need the research which incorporates the subjective and the personal if we want the findings to be relevant to the real, everyday lives of human beings.

Right up in the “Results” section of this paper the authors say “Experiences of support, recognition and belonging, on the other hand, can help to strengthen or restore a state of health”. That is completely congruent with the clinical experience of my lifetime’s work as a doctor. The essential elements of healing are based on the relationship – as a doctor it is my role to recognise each patient – to see each one as a unique individual with a particular issue or problem to discuss – and to be able to say “I see you”, “I hear you” and “I understand what you are experiencing” (and that includes making a diagnosis and being aware of the natural history of diseases). It is also my role to support, not judge. To provide what help and care I can. And finally, at the base of it all, it is my role to create a relationship with each patient, a meaningful connection which reduces the feelings of isolation or alienation a person who is suffering can experience.

It is heartening to see the beginnings of a scientific method which will help us all in the future to create the conditions for health. And if the start of that is to create “Experiences of support, recognition and belonging”, then we will be starting from a good place.