Wilberg on Wednesday - The Illness Is The Cure pt 25/46

The Language of Illness

Could it be that the way we use language to talk about illness and disease affects our whole understanding of it? Could it be that “the essence of a disease” and “the essence of a word” – of the language with which we describe states of ‘dis-ease’ – are one and the same?

To begin with it is important to recognise how many phrases used to talk about illness contain words that imply that it is:

• some ‘thing’ that we ‘have’, ‘catch’ or ‘get’
• something that is ‘wrong’ or ‘bad’
• something that attacks us
• Something that fails

Examples:

• I caught a cold.
• She has cancer.
• What’s wrong with me?
• He’s got a bad heart.
• My back/head is killing me.
• He is suffering from liver failure.

Secondly, biological medicine, far from being based purely on scientific fact, is pervaded by verbal metaphors or figures of speech – and in particular expressions derived from the language of war.

Examples:

• War on cancer.
• Defending or protecting oneself against disease.
• Battling, struggling or fighting against an illness.
• Mobilising/reinforcing the body’s immune defences.
• An aggressive tumour or virus.
• Fighting off an infection.
• Killer cells.

Thirdly, illness has been explained and interpreted historically in many different religious, moral and ‘scientific’ ways.

Examples:

• As a punishment for sin.
• As a ‘test’ of will or faith.
• As an attack by malign spirits.
• As a result of misdeeds in a past life.
• As a sign of moral ‘degeneracy’ (syphilis, AIDS).
• As an evolutionary means for the survival of the fittest.
• As an invasion by pathogens such as bacteria or viruses.
• As the ‘price’ paid for an ‘unhealthy’ lifestyle.
• As a result of eating the ‘wrong’ foods.
• As a colonisation by cancerous cells.
• As a result of faulty genes.

Fourthly, the body itself has been culturally and linguistically described in many different ways:

Examples:

• As an image of God.
• As a sacred temple of the gods.
• As something to be controlled or tamed by the mind.
• As a container of emotions and of the soul or psyche.
• As a mere disposable shell of the soul or spirit.
• As a more or less well-functioning machine.
• As a product of our genes.

Body Language in Everyday Speech

Everyday speech and verbal language is itself full of ‘body language‘ – containing countless metaphors or ‘figures of speech’ which not only refer to bodily organs and functions but offer symbolic clues to types of inner dis-ease that might find expression in both physical and mental health problems.

Examples:

• To be/feel inflamed, to be thick-skinned or thin-skinned, sensitive or prickly, irritable or itchy, to be touched or untouched by something/someone, to let something/someone get under one’s skin.
• To be heartless or cold-hearted, to take something to heart, to be disheartened, to lack heart or lose heart, to be heartbroken, a heartfelt emotion, a fluttering heart etc.
• To find something hard to stomach or digest, to feel sick or nauseated about something, to have a gut feeling about something, to feel gutted.
• To not feel one can breathe freely, to feel stifled, to feel one has no room to breathe, to lack breathing space, to lack inspiration (from the Latin spirare – to breathe).
• To be headstrong, to be boneheaded, to keep a clear head, to head in a certain direction, to make or not to make headway, to head something off, to have a head for something, to lose one’s head, to bring something to a head etc.
• To be unable to face or face up to something or someone, to come face to face with something or someone, to show one’s true face.
• To not see a point, to refuse to see something, to not see straight, to not see things in perspective, to lack vision or insight, to be short-sighted, to close one’s eyes to something, to have a blindspot, to not have an eye for something.
• To stand on one’s own two feet, to find one’s balance or ground, to stand up for oneself, to take things in one’s stride.
• To lack backbone, to be spineless, to back someone up or to be in need of support and backing.
• To feel inwardly frozen stiff or immobilised.
• To shoulder a burden or lean on someone’s shoulders.
• To feel something as a pain in the neck or a pain in the ass.
• To feel overstretched, stressed, stiff, constricted or tense.
• To feel someone getting up one’s nose.
• To be unable to handle or get a grip on a situation or person.
• To be full of bile.

Even simple linguistic prepositions such as ‘in’ and ‘out’, ‘on’ and ‘off’, ‘up’ and ‘down’ etc – all of which form part and parcel of the very structure of language – play a particularly significant role here, implying that the body is a container of some sort for mental and emotional objects.

Examples:

letting something ‘out’, taking or holding something ‘in’, having an idea ‘in’ one’s mind or a feeling ‘in’ one’s body, letting ‘out’ an emotion, feeling ‘off’ or ‘put off’, going ‘into’ oneself or letting things ‘out of’ oneself, feeling ‘up’ or ‘down’, ‘high’ or ‘low’, trapped ‘in’ one’s body or ‘out of’ one’s mind.

All these expressions arise from and reflect our felt bodily relation to space – as also does the use of words such as ‘upset’, ‘unstable’ or ‘imbalanced’ and expressions such as ‘leaning to one side’, ‘finding one’s ground’ or ‘shifting’ one’s stance, attitude, posture or position.

That language itself is ‘body language‘ can also be seen from the way in which expressions referring to ‘mental’ states make use of figures of speech but relating to specific bodily sensations or movements:

Examples:

feeling ‘overstretched’ or ‘under pressure’, ‘reaching’ for a goal, ‘catching’ or ‘catching onto’ something, ‘running away’ from something’, ‘moving on’ and ‘getting ahead’, ‘falling behind’ or ‘going downhill’, ‘falling apart’ or putting oneself ‘together’, ‘shaking’ with fear or ‘shaking’ something off, ‘shifting’ one’s attitude, ‘carrying’ a heavy burden, ‘grasping’, ‘hanging onto’, ‘losing one’s grip on’ or ‘letting go’ of something etc.

These are examples of a whole range of expressions used to refer to ‘mental’ states which at the same time refer to muscular states. For example we speak of feeling tense or relaxed, or else nervous or restless – hence wanting to fidget or make use of our muscles in some way.

Similarly, a state of high tension or anxiety may be felt muscularly – for example as a ‘tension headache ’, a ‘knot’ in the stomach, a ‘flutter’ in the heart etc. This is not surprising given that our heart, stomach and intestines are made up of muscle – as are our respiratory and vocal organs.

If someone is drunk or drugged is it their mind or their muscles that may make them feel disoriented or lose their balance? Perhaps it is both and neither. Perhaps it is a person’s overall or underlying bodily mood or tone of feeling which finds expression both in muscle tone and in mental states.

Hence also the expression ‘highly strung’ – which can apply to both a person’s nerves and their muscles, but is drawn from the language of stringed musical instruments – and suggests an understanding of the human body or ‘organism’ itself as a musical instrument – the meaning of the Greek word organon.

Finally, both our language and our muscles and joints can be more or less rigid and stiff or articulate – allowing us to freely communicate or ‘articulate’ ourselves through both verbal speech, different tones of voice and ‘body speech ’. Could it be then, that both illness and language, bodily symptoms and bodily figures of speech – what Foucault called “the essence of a disease” and the “essence of a word” – are one and the same? Could it be that illness gives this common essence the form of symptoms, whilst language gives it the form of bodily metaphors or figures of speech? Could it be that the body itself is a not a biological machine to be repaired but a living language of the human being? For verbal language, as we have seen, is itself largely ‘body language‘ – being made up of figures of speech rooted in bodily sensations and states.

Illness as a Language and ‘Somatic Metaphor’ – Cases from the work of Dr. Brian Broom

The following case reports are drawn from Dr. Brian Broom’s book Meaning-full Disease – how personal experience and meanings can cause and maintain physical illness. They are based on the approach to illness taught by Brian Broom to health professionals at the Auckland University of Technology and first detailed in his book Somatic Illness – the Patient’s Other Story – which contains a wealth of further case descriptions. Broom’s ‘MindBody’ approach – like that of Life Doctoring – consists in exploring the nature of a patient’s illness as ‘somatic metaphor’. This means listening for and hearing in the patient’s own language and choice of words evidence of clear metaphorical connections between the patient’s somatic symptoms on the one hand and particular events and experiences in their lives on the other. In all the cases that follow, names of patients have been changed and any similarity to persons known to you reflects the commonness of such connections but also the essentially symbolic nature of illness as ‘somatic metaphor’.

Skin thickening

Eunice, a 71 year old woman, had an 18 month history of generalized thickening of the skin, and tissues under the skin, causing uncomfortable splinting of the chest, and tightness of the arms and upper legs. This thickening was very obvious. Despite her age it was impossible to pinch her skin into folds. Despite intensive investigation a firm diagnosis had not been made. I will not emphasise the medical detail but though the appearances were not classical she was told she had “connective tissue disease” and was accordingly treated with steroids and other potent drugs.

I was asked to see her for a second opinion. I began by enquiring about the onset of her skin thickening. She startled me by saying that it began when she fell over in the local garden nursery, sustaining injuries to her face and legs. I was inclined to brush this information off, and get on with the important (sic) material. But something made me hesitate, and I enquired further. She described the fall as “shattering.” Mystified as to the relevance of this I asked what effect this event had had on her. She replied: “ I went into my shell for a while.” I was immediately struck by the fact she was presenting to me with a thickened shell of skin and here she was using language to match. I invited further comment, and within the next 3 to 4 minutes she used the words “I went into my shell” 3 times. Moreover, she further volunteered in her description of being taken back to her home by a friendly gentleman: “I went inside the four walls of my house, and closed the door, and sat and sat and sat.” In the few weeks following the injury skin thickening developed first in the legs and then became more generalized. I sat listening to this wondering what sense to make of it. I enquired about aspects of her life. She had enjoyed very good health throughout her life, but it seems that the accident compromised (“shattered”) her sense of herself as perennially invulnerable. Moreover the embarrassing injuries to her face induced social withdrawal. She had actually started to improve by the time I saw her and the possibility existed that this was a response to the drugs she had been on. I enquired of her as to what she felt was the cause of her improvement. She related it to a friend who had come to her and said that she should get active again. She said that she improved again as she started to “come out of my shell.” This “shell” theme was the metaphor she persisted with in both her language and her body.

I suggested to her that the thickening of the skin was a bodily (somatic) representation of what she was also expressing in using the term “shell.” She accepted this, though without much insight. I encouraged her to continue to be active and resume her previous social contacts, and suggested I follow her up regularly for support, encouragement, explanation, education, and revision of her home situation so that coping could be ensured for as long as possible. After the third visit she declined further sessions. One year later both she and her physician reported marked clinical improvement, and she was on no medication.

Leukoplakia

Teresa requests review because she wants to ‘live life more fully’. In her thirties she developed leukoplakia, a precancerous condition of the mouth. By the time she came to me she had had seven surgical interventions, including removal of carcinoma and one plastic reconstructions of the tongue and the floor of the mouth--the last requiring eighteen months rehabilitation as she learned to speak again. Early in the interview she proffered the interesting comment that “if only I could get rid of it (my emphasis) I would be able to live more fully from day to day”. Though she was obviously (!) referring to the leukoplakia and cancerous tendency I suspected the it was not the cancer that had been removed 2 years before, with no evidence of recurrence. I noted the words but made no comment.

A review of her life-story was illuminating, and some key points will be emphasised. Apparently, after she was born, she and her mother were collected by father from the hospital. He dropped them off at home and went off to see his mistress. When Teresa was seven years old her father suicided, though she was not aware of the nature of his death. At age twelve she was crying in her bedroom. Mother found her, asked what was wrong, and Teresa replied that she was crying about “daddy”. Mother, who was now alcoholic, responded: “It’s your fault your father is dead – you would never sit on his knee.” The background to this cruel comment is not clear. Teresa did remember that as a child she often felt much more identified with her absent father than with her mother. At age sixteen she learned from relatives that her father died by suicide. At nineteen she entered a marriage that, over six years, repeated in some ways the traumas of childhood. At age thirty three she developed the leukoplakia of the mouth. It turns out that this was the age that her father committed suicide. Her father was an oral surgeon. I point this out to Teresa who has herself wondered, over the years, whether this is significant, though it had never been discussed with doctors. Returning in my mind to the it referred to above, I asked her what, apart from this cancerous tendency, she would most like to get rid of in her life. She seemed to understand what I was asking, but struggled initially, becoming very tearful, unable to find the right word. Eventually she said she most wanted to get rid of the shame. To me it seemed likely that the shame and the leukoplakia were intimately connected in some way. Could one think up a better somatic metaphor than a precancerous condition of the mouth, for the shame of being responsible for the death of one’s oral surgeon father?

Teresa had some brief psychotherapy, which was unusually fast-moving and involved only nine sessions. The turning point in therapy occurred when she actually started to remember sitting on her father’s knee. She reported, after the session in which that occurred, a persistent “joy” which has continued, and seems to have expressed itself in a variety of interpersonal and social freedoms. A year later she reported no further problems and her surgeon expressed astonishment with the good state of her mouth.

Nasal irritation

Katrina, a woman in her twenties has struggled with obesity since age thirteen. Finally she conquers it by having a gastric bypass operation, losing some 60 kilograms in weight. At last the obesity is behind her. But the problems associated with her obesity appear in another form. She works as an acupuncturist. Since losing weight, and transcending her enormous weight problem, she has become more and more irritable with clients who seek her help for what she sees as relatively trivial bodily concerns. Compared to her struggle with obesity many of these clients have little to complain about. She no longer wants to tussle with ‘bodies’. As this irritability increases she develops chronic nose and sinus catarrh, congestion, and infections resistant to antibiotics. She ‘can hardly bear to face’ some of these clients. Her nose may settle for a while when away from clients, but as soon as she leans over these troublesome clients demanding solutions to their ‘trivial’ problems her nose starts to pour fluid. They get ‘up my nose’.

Vertebral arthritis

A couple were referred because of marital difficulty … In the course of the first session he complained of back-pain, and we enquired further about this. He had been previously diagnosed with ankylosing spondylitis, which is an inflammatory arthritis of the vertebral column leading, eventually, to a rigid fusion of all the vertebrae. Asked when the problem began, without any hesitation he gave the following intriguing story. Seven years before he had been present at his wife’s first labour, during which an epidural anesthetic was given. He was absolutely appalled at the sight of the needle being inserted into his wife’s spinal column, and collapsed in a faint on to the floor. He woke up with pain in his back, and had been “feeling her pain” ever since.



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