Posts Tagged ‘science’

There’s a chapter in James Hollis, the Jungian analyst’s book, Creating a Life, entitled, “Attending the Soul”. This particular chapter is about the practice of psychiatry and he completely nails an important point.

If we consider health, acute and chronic illness, to be a spectrum of experience, then we need to do more than control or manage disease in order to be healthy.

Here’s how James Hollis puts it….

In seeking scientific verification of success, many of these practitioners [psychiatrists] have narrowed the definitions of pathology to behavioural patterns, faulty cognitions and flawed chemistry. While it is certainly true that we are behaviours, and behaviours may be corrected, and we are cognitions which may be challenged by other cognitions, and we are chemical processes which may be compensated by other chemical processes, none of these modalities – behaviourism, cognitive restructuring and psychopharmacology – should be confused with psychotherapy.

He goes on to say that psychotherapy seeks to address the whole person, even the meaning of the person, the meaning of their suffering or even the meaning of their life.

This same point applies across the whole of Medicine. Illness may include physical pathologies which can, and may, be addressed with drugs or surgery, or it may include adaptive, or protective symptoms and behaviours which can be changed. However, if we are interested in healing, in facilitating the experience of wellbeing, resilience, and health, then we face the fact that a whole human being is more than the sum of his or her parts.

Here’s how he concludes his chapter…

To stop at behavioural change, as important as it is, or cognitive restructuring, liberating as it may be, and pharmacology, necessary as it sometimes becomes, betokens a failure of nerve and sells the soul very short indeed.


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Your other brain?

You probably imagine that you do all your mental work – perceiving, analysing, thinking, feeling and so on – with your brain – that organ inside your skull. However, we’ve known for some time that there are networks of neurones around the hollow organs of the body, especially around the heart and the intestines. We’ve also discovered “neurotransmitters” originating from those parts of the body. So, at very least, we are aware that there are two way connections between the heart and the brain, and the gut and the brain.

A recent article in New Scientist magazine described the network around the gut and named it the “Enteric Nervous System” (ENS). There are around 500,000 neurones around the gut (where there are about 85 billion in the brain). Most surprisingly, alongside the 40 or so neurotransmitters in this network, two chemicals known to affect mood and mental functions, dopamine and serotonin, are also present. In fact, it is now thought that 50% of all dopamine is produced in the brain, and 50% in the ENS. Only 5% of serotonin is produced by the brain, and 95% of it in the ENS. This is quite astonishing when you consider the roles these hormones can play in our behaviour.

The other fascinating fact the author of the New Scientist article highlights is the presence of Lewy bodies in the ENS (these are the pathological lesions seen in the brains of patients with Parkinsons Disease), and patients with Alzheimer’s have characteristic lesions on both their brain and ENS neurones. Do those “neurological” diseases begin in the brain, or in the gut?

It’s good to see scientists discovering how interlinked our bodily systems are, and how difficult it is to reduce a person to parts – even the two parts of Mind and Body. Are those parts really such separate parts of they are so connected and inter-related?

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The Scottish Storytelling Centre in Edinburgh hosted the International Storytelling Festival last week and I participated in a series of workshops entitled “Stories and Cures”. What a fantastic, stimulating, rich experience with a diverse range of nationalities and disciplines taking part. Right at the start of the week I heard something I’d never heard before.

Back in the 18th and early 19th centuries throughout Europe when a person wished to consult with a doctor, there was a practice of letter writing. Someone would write a letter to the doctor whose advised they wished to receive. The letters were typically the person’s story, in their own words, describing what they were experiencing and the contexts of those experiences. In other words, the letters weren’t just lists of symptoms, and certainly weren’t tables of figures or readings, but, rather, they were highly personal, unique life stories.

The doctor would then write back, commenting on parts of the person’s story and giving a range of advice , often touching on issues of morals, hygiene or spiritual life. This was the beginning of a conversation which might be followed up with further exchanges of letters and/or with meeting up for face to face consultations.

Joanna Geyer-Kordesch, whose research as a Professor of the History of Medicine was the basis for this series, has read hundreds of such letters in English, German and French.

I didn’t know such a practice had ever existed.

Just think for a moment how different this practice was from our current doctor-patient relationships.

First of all, the record of the person’s illness is now created and held by the doctor. The stories have been turned into case notes and typically it would be extremely difficult to gain any understanding of who the person is if you were to read these notes. Doctors notes (I don’t think they usually could be stretched to be considered as stories) are mainly lists of symptoms, physical findings and results of investigations, then diagnostic labels based on pathology. The advice recorded certainly isn’t in the form of a conversation or exchange with the patients. In fact advice is more likely to have been replaced by a list of drugs prescribed.

What are the consequences of this change?

There has been a shift in power – from the person to the doctor, or the institution. This shift in power is so great that the words recorded are much more likely to be the doctor’s words and his or her interpretations of the person’s experience, rather than any record at all of the story the person has told (it’s not like that where I work because we have a tradition of writing down the patient’s actual words as much as we can – however, it’s still the doctor making and holding the record, not the person whose life it is)

There has been a shift in focus – from the person to the pathology. As Eric Cassell so beautifully describes in his “The Healer’s Art”, and “The Nature of Suffering”, illness is what the person goes to the doctor with and disease is what he comes home with.

It seems to me we’ve lost sight of the human being in the process. By reducing someone to a mere physical body to measured and imaged, we have dehumanised Medicine. The PERSON has been lost. How do we get the PERSON back into the centre of the stage? How do we get the individual’s agenda back at the heart of the medical engagement? How do we regain the truth of the uniqueness of every single human being and move away from the mass production processes of reducing people to diseases, diseases to “managed”, rather that people to be healed?

A good starting place would be to enable people to tell their stories – in their words, in their order of priority, in their own style – to reveal not just their sensations and experiences, but also their choices, their values and their beliefs (and what about the creation of the record? How and where would you create the record of your illness and your healing?)

Maybe valuing each individual’s story would begin to let us re-humanise Medicine?

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