Heroes Not Zombies

Tim Parks’ excellent “Teach Us to Sit Still: A Sceptic’s Search for Health and Healing” was recently reviewed by one of the British Medical Journal’s Associate Editors.

By now you must be as bored as I was. And we still haven’t reached the dénouement. I don’t think that I shall be spoiling anything for anyone if I say that eventually he found that learning to meditate brought an end to the pains, although he doesn’t say whether he can pee any better.
Obviously this book wasn’t written for doctors, and I’m doubtful whether they will enjoy it much. They will have heard versions of this story many times before from their own patients whom they tried hard, but failed, to help. Indeed at one level this particular narrative is little more than a long and self absorbed account of the inner journey of a man desperately seeking meaning in and relief from chronic (but not incapacitating) symptoms, who eventually manages to find both through visipanna meditation. Yet before dismissing it entirely it’s worth remembering that the author is a successful writer and academic—one of his novels was shortlisted for the Booker prize—and probably a lot cleverer than we are.

You can tell he didn’t like it.
Having just read the book myself and found it thoroughly engaging, and thought provoking, I thought the BMJ’s review showed just what’s gone wrong with medicine with these days – doctors shouldn’t find patients’ stories boring. They shouldn’t find them irrelevant, nor should they believe that their own take on illness or health is superior to that of the person they are trying to help. What happened to compassion? When did human beings become the boring part of medicine? Interestingly, there are clues in Parks’ own text. Consider these two statements –

What’s the point of speaking when you’ve arranged to do proper clinical tests? The tests will speak for you.

and

Without evidence of organic damage pains were perhaps unimportant. At least to doctors.

I’ve had junior doctors tell me they are being taught exactly these views – that only clinical tests show the “truth” and that patients’ stories don’t matter. This doesn’t bode well for the future practice of medicine.

In fact Parks predicts the BMJ editor’s response –

Doctors had never wanted to go into detail over this, as if afraid that an exhaustive description of symptoms would mean losing themselves in a labyrinth of highly nuanced but irrelevant sensation.

But the editor is right. This is not an uncommon story. That, however, certainly does not make it boring. This is a good read. It’s an engaging and thoroughly honest, open account of a chronic problem which the best of “evidence based medicine” could do nothing to help. That too, is not an uncommon story.

Given that Tim Parks describes himself as a “skeptic” (though I think that label is much misapplied these days….seems the average “skeptic” is actually someone arrogantly convinced of the rightness of their own personal view, only doubting everybody else’s!), it’s interesting to find him saying this (comparing his mother and father’s evangelical Christian fundamentalism to their belief in modern “scientific” medicine”) –

..like doctors’ syrups, divine healing required no effort or self-knowledge on the part of the sufferer; neither my father nor mother paid much attention to their bodies.

One of the most important points he makes is –

Wasn’t it weird, in fact, the way everybody imagined that when you were ill all you had to do was go to a doctor and get yourself prescribed a medicine? How did that happen?

He’s right. How did that happen? And isn’t it weird? Health isn’t about getting a pill, and doctors don’t always know best. Trust me. I’m a doctor.

Finally, referring to John Launer’s suggestion that “MUS” should mean “Medically Unexplored Stories”, instead of “Medically Unexplained Symptoms”, the reviewer concludes –

Perhaps he’s right. If so, the moral of the story told by Parks is that intelligent, educated, and apparently rational people may think about their health and illnesses in ways that hardly begin to overlap with ours.

You know, it’s not about intelligence, education or rationalism, it’s the biotechnical doctors who have lost the plot. It’s their way of thinking which hardly begins to overlap with that of their patients, and as health is a personal and individual experience, the most important story is the patient’s one.