Wilberg on Wednesday - The Illness Is The Cure pt 27/46

Life Medicine and Organic Impairment

It is the organising or ‘ordering’ capacities of the lived body and physical soul that allow us not just to remain open to, sense and feel, take and breathe in, digest and metabolise our experience of life but also to:

(a) make sense of our lives and life world in an organised and ordered way, and

(b) engage in our lives and relate to our life world in a meaningful and fulfilling way. This is achieved through what the existential physician and neurologist Kurt Goldstein called “ordered performances”.

By this he meant ordered activities or patterns of action of any sort that we are normally able to enact within or in response to our life world or environment – whether basic actions such as breathing, moving, walking, talking, clothing ourselves, cooking, eating or fulfilling domestic tasks etc., or more sophisticated ‘performances’ such as engaging in highly skilled creative, communicative or professional activities and interactions.

Chronic or permanent loss of or impairment to organs and organic functions (for example loss of mobility, sight or hearing) impair and limit such ordered life activities or ‘performances’. They also affect and express states of our organism as a whole and are felt through ‘generalised’ organismic states such as fatigue, depression, loss of cognitive capacities or libido etc.

From the perspective of Life Medicine however, to see biological ‘death’ resulting from organ failure as the end point of our being or existence is to forget that the lived body, being a non-physical body of feeling awareness or soul – our ‘soul body’ – is by nature eternal.

Therefore what is essentially threatened by a continued or worsening organic impairment – even if ‘life threatening’ – is not any form of ‘absolute death’ but rather what is of absolute importance to the current life and health of the patient in this life and this world i.e. their capacity to actualise their individual potentials by means of specific organic capacities and the ordered ‘performances’ or patterns of action they facilitate. For as Goldstein wrote:

“…health is not an objective condition which can be understood by the methods of natural science alone. It is rather a condition related to the mental attitude by which the individual has to value what is essential for his life. ‘Health’ appears thus as a value; its value consists in the individual’s capacity to actualise his nature to the degree, that for him at least, is essential.”

If this understanding offers us a deeper insight into the true essence of ‘health’, what then are its implications for our understanding of the essence of ‘illness’? In the context of organic impairment this question takes us beyond the purely clinical realm of biological medicine and takes us once again into the realm of personal life meaning.

For example, a partial loss of movement in a leg may mean very little to a sedentary worker but everything to an athlete such as a runner or sportsman, just as a speech impairment may mean much less to a manual labourer but everything to a salesman, teacher or writer – inducing an overall organismic reaction that Goldstein calls ‘catastrophic’ shock and anxiety – being a threat to the very essence of the individual’s ‘life’ or ‘existence’ understood as a means of self-actualisation. On the other hand a patient may be known to have a ‘disease’ in a potentially ‘life threatening’ cancer without this in any way outwardly affecting their capacity for self-actualisation through specific patterns of action or organised ‘performances’. If, as a result of this ‘disease’ diagnosis however, the life world and life possibilities of the cancer patient are shrunk down to merely being kept alive in a hospital bed and/or subject to hi-tech radiological or chemotherapeutic treatments which radically reduce their quality of life – then it is difficult to argue that this type of ‘medicine’ in any way benefits their ‘health’ in the sense defined by Goldstein.

As for illness or ‘disease’, he writes:

“It may be stated as certain that any disease is an abnormality but not that every abnormality is a disease.”

So for example, when people get ill through ‘stress’ i.e. when demands far beyond what Goldstein calls their “average potentialities” are imposed on them – they may recognise an abnormality in their condition, for example feel ill with the symptoms of a cold or flu – an ailment – but they do not regard themselves for this reason as having ‘a disease’.

In general however, whatever ‘symptoms’ may be observed, such as high blood pressure, or whatever ‘diseases’ may be bio-medically diagnosed as a result – for example heart disease – all that has actually occurred is a deviation from a biological norm.

Yet this scientific norm may have little to do with a patient’s own highly individual norm for assessing their own ‘health’ – understood as their capacity to lead a healthy and fulfilling life.

What biomedicine judges by its own purely biological norms to be a ‘disease’ therefore, is in essence nothing more than an observable change of state of the organism, one that may not only be more or less temporary – but also more or less meaningful, threatening or catastrophic to a patient’s experience of life – not just the life of their physical body.

For as Seth explains (see appendix 6)

“The body does not recognise diseases as diseases in usually understood terms. It regards all activity as experience, as a momentary condition of life, as a balancing situation.” (from The Way Toward Health by Jane Roberts)

Yet biological medicine understands its primary purpose as to fight disease and prevent death at any cost – qualitative and quantitative – to the life of the patient. This implies that disease is merely and invariably an abnormality with no meaning – and that life itself consists merely in just continuing to ‘be alive’ or ‘survive’ biologically, rather than living in a way that brings a necessary, minimum degree of self-actualisation and fulfilment (the essence of ‘health’).

That is why, in cases where a patient is left with a remaining deficit or chronic and incurable organic impairment which more or less severely limits their capacity for a particular type of ordered “performance” or life activity, Goldstein ’s view was that it was of the utmost importance for the individual to find ways to re-order and if necessary limit their life world itself – what he called their “milieu” – not through mere institutionalisation or for the purposes of medical treatment but in a way that:

1. reduces the demands imposed on the individual to respond with “ordered performances ” to an extent they are no longer capable of or can cope with
2. nevertheless provides the patient with an ordered environment in which they can still continue to engage in fulfilling forms of ordered activity, old or new.

Though Goldstein dealt with patients suffering from severe neurological damage, this also applies to people with far less severe illnesses or even minor ailments – to which they might respond by taking days off work, staying at home or in bed etc. – all of which are simple ways of temporarily limiting their life world to a less demanding or stressful “milieu” – but one in which they can nevertheless engage in some satisfactory ordered activities or work of some sort.

‘Order’ is in this way central to Goldstein’s view of organic impairment, suggesting a manner in which the physician could serve as a ‘life doctor’ in the most literal sense – restoring a minimum degree of healthily fulfilling and ordered activity to the patient’s life and well-being rather than seeking only to cure or alleviate a physical disease or impairment.

“…being well means to be capable of ordered behaviour which may prevail in spite of the impossibility of certain performances which were formerly possible. But the new state of health is not the same as the old one … Recovery is a newly achieved state of ordered functioning … a new individual norm.”

With this final emphasis, Goldstein affirms that the new norm, like the old one, must be an individual one and nothing imposed from without – based on ordered activities satisfying to the individual’s essential nature – even if a portion of this ‘essence’ may have permanently lost its capacity for a full, undefective and ordered expression.

Life Medicine, like the reflections on health and illness that form part of the ‘existential neurology’ of Goldstein, also affirms the significance of free choice on the part of the patient. Thus there may be a situation in which a patient must freely decide whether and to what extent to either limit his or her existing life world and its ordered activities in the face of particular limits to their capacities or to continue to engage in these activities as before despite the pain or suffering that accompanies them (for example by staying in an over-demanding job).

Whatever the patient decides – with the potential help, encouragement and counselling of the physician as ‘life doctor’ – the outcome is a way in which the patient freely decides to adapt his or her environment or milieu to his own needs and desires – rather than being forced to adapt to them.

Recognising this, we have immediately transcended the one-sided Darwinian notion that organisms survive and thrive solely by adapting to their environment – rather than by adapting that environment – their life world – in a way that best serves their essential health and well-being.

This is also significant given that most people live in two environments or ‘life worlds’. One is a ‘negative environment’ in which social structures and economic conditions actually and constantly deprive individuals of potentials for healthy self-actualisation and instead overload them with demands unrelated to these potentials – often to the point where they cannot ‘cope’ with these demands or the lack of fulfilment they get from meeting them. As a result people get ill simply by virtue of adapting to a fundamentally unhealthy or sick social-economic environment – and are medically treated simply to restore their capacity to function economically in a way that serves that environment.

The other environment is whatever ‘positive’ environment, life world or milieu individuals are able to forge for themselves within or outside their ‘negative’ environment. This positive environment is one that genuinely serves the individual’s need to take time, not just for rest, recuperation or distraction from the ills and illnesses induced by their negative environment, but also and above all for activities that serve their positive self-actualisation, and with it their essential life health – something that has nothing to do with so-called ‘healthy lifestyles’.

Reference: Goldstein, Kurt The Organism


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